KEY 4:

FEEL YOUR FEELINGS, CHALLENGE YOUR THOUGHTS

You could say that the biggest key to my recovery was learning how to take care of myself in a real way, instead of starving and always trying to lose weight. I began to value always delving deeper, peeling the layers of the onion, and finding the “root” causes to my behaviors, and the feelings that had to come out.

—RL

Gwen: “What am I supposed to do with all these feelings?”
Carolyn: “Feel them.”

Identifying your underlying issues can bring insight and awareness, but just understanding is not enough to make you well. It’s not what happens to us, but what we do with what happens to us, that makes the difference. You will have to learn to deal with your thoughts and feelings in healthier ways in order to get better. You can never undo the past or change the fact that you were born with “anxious” genes or were teased in school, but you can work on managing or lessening your feelings of anxiety. You can learn to identify the thoughts you have, and the things you continue to tell yourself. You can learn to accept, tolerate, and feel your feelings. Learning how to identify, understand, and regulate your thoughts and feelings will help you figure out what you can and can’t do about a situation, and help you make better choices in your life. Your eating disorder behaviors have been driven by your problematic thoughts and feelings, and possibly served to numb, distract, filter, express, or otherwise manage your feelings.

How Coping With Weight Turns Into Coping With Other Problems

Your eating disorder can be connected to your thoughts and feelings in numerous ways. Some people actually recognize that their problems with food began when they started using food as comfort for or distraction from painful feelings. Others will say the only “feeling” that drove their behavior initially was “feeling fat,” and they are unsure if or how their behaviors help them deal with other feelings. Let’s look at some examples.

Let’s say that an eating disorder behavior, such as restricting all carbohydrates, starts as a way to lose or control your weight. If you are successful, other people compliment and praise you, you feel good about yourself and the behavior is reinforced. Initially, all of the attention and your feelings of accomplishment boost your self-esteem or feelings of self-worth. As you continue, you enjoy the feelings of success and accomplishment.

Let’s look at another example. If you are trying to lose weight and think that eating desserts are bad and you are not “allowed” to eat them, what thoughts and feelings arise if you eat a piece of cake? You might think you are weak and undisciplined and you feel guilty, ashamed, or something similar. Then, let’s suppose that to get rid of those calories you purge. If purging reduces your guilt or shame, then purging is being reinforced as a coping mechanism for whenever you break your dieting rules. If purging becomes the way you get rid of food you consider “bad,” the next time you eat cake you might think that since you broke the dessert rule anyway and you are going to purge, you might as well eat several pieces of cake or even other things you don’t “allow” yourself to eat. Depriving yourself of certain foods usually causes feelings of rebellion and intensified desire. At some point, the behavior that started out as a way to “fix” or cope with anxiety, guilt, or shame about eating transfers to other areas. For example, if you fail a test and you feel guilty and ashamed, you may think, “I can get rid of these feelings by bingeing and purging.” Now you have transferred your eating disorder behaviors from a way to deal with negative feelings about food and weight to dealing with negative feelings in general. Another example of this is that restricting what you eat may make you feel in control and powerful over food or your body, but over time, this tendency starts to be confused with feeling in control and empowered in other areas in your life. One last example is that clients who struggle with compulsive eating find themselves eating to numb or cover up the bad feelings they have about what they just ate, and eventually to numb out other bad feelings in general.

If your eating disorder goes on long enough, it can get to the point where you don’t even need anything negative to happen to trigger or instigate an eating disorder behavior. Repeatedly engaging in eating disorder behaviors will cause them to become habitual, and you will find yourself engaging in them just because you “can” or just out of habit. The eating disorder becomes a way of maintaining homeostasis. Similar to an alcoholic who wakes up and drinks, the illness can get to the point where nothing particular is causing you to restrict or binge or purge, you just do it habitually. In fact, not doing it makes you uncomfortable. When an eating disorder is very entrenched it becomes a coping mechanism to just help you get through the day. You probably don’t even realize all of the things you might be feeling if you weren’t engaging in the behaviors. Eating disorder behaviors keep your feelings out of your awareness. Stopping the eating disorder behaviors is important and necessary to understand and feel your feelings. If you stop your automatic behaviors, we guarantee you that thoughts and feelings will come up.

Thought-Feeling-Urge-Action Chain

We have found a simple way to help our clients understand, dissect, and change how their thoughts and feelings lead to their eating disorder behaviors. If you are at the total habituation stage of your eating disorder, the following information will be harder to take in, but it is still possible to do. Whenever you have a strong, triggering feeling, you will have an urge to react and cope with it in the best way you know how. If you are like most of our clients, you are coping by using one or a combination of the following behaviors: restricting your food intake, which often serves as an illusion of strength and self-control; bingeing to escape, numb, or comfort yourself; or purging to get the feeling out of you, experience relief, or lower your anxiety. The chain reaction looks like this: Thought–Feeling-Urge-Action.

Thoughts

Your thoughts are the beginning of the chain reaction. Most people greatly underestimate the influence their thoughts or “cognitions” have on their feelings and behavior. If you have an eating disorder, you will find it is accompanied by disturbing, distorted, and unhealthy thoughts. These thoughts result in painful feelings and destructive behaviors. When working with clients we are always asking them, “What do you tell yourself about that?” This helps you uncover what you are thinking and telling yourself about the experience you had, or are having, or are afraid of having.

Feelings

Many people want to avoid or get rid of their feelings and get upset when they can’t. The truth is that you can’t control your feelings, but you can control how you perceive them, express them, or defuse them, and what you do about them. Getting down on yourself for having certain feelings is a waste of energy and will only make you feel worse. The goal is to accept, understand, and feel your feelings, discharge or separate them from your body, and move on.

Urges

Whether it is an urge to eat or not eat, binge or purge, urges are hard to control, but they can teach you a lot if you don’t react immediately. Not reacting to the urge is sometimes called “surfing the urge,” which is essentially just feeling your feelings and riding them out before reacting. You need a little time to become aware of what is underneath the feeling, and also time to figure out and separate any thoughts that might be fueling the feeling and making you feel worse. Initially your urges will be quite strong, but the good news is that your habitual urges will lessen and change considerably over time as you develop better ways of coping or reacting.

Actions

Using your eating disorder to cope with your feelings is, at best, a temporary way to make feelings go away. If your real underlying feelings are completely unattended to, they will keep resurfacing. Giving in to the urge and going to food, or away from food, to “fix” any feeling will ultimately fail you. You might be afraid to actually feel, express, and take appropriate action related to your feelings because you are afraid of hurting others, being judged, or harming a relationship. Maybe you have been labeled as “overly sensitive” and are purposely trying not to act on your feelings. As you learn to feel your feelings and express them in healthy and effective ways, they will begin to inform your actions rather than control them.

The Power of Thoughts

Your thoughts, which are based on perceptions or beliefs you have learned from outside sources or come up with yourself, often contain inaccurate information that can mislead you. Our goal is to help you learn to recognize and challenge your destructive thoughts that might be sabotaging or getting in the way of recovery or fueling your behaviors. Cognitive-behavioral therapy (CBT) is a well-known psychotherapeutic approach and has been shown to be the most useful approach for treating bulimia. We have found it extremely beneficial with all of our eating disorder clients. CBT is based on the idea that it is our thoughts that cause our feelings and behaviors. This means that if we want to change our feelings and behaviors, we need to look at and then work on changing the way we think. We have the power to change our thoughts even if we don’t have the power to change the situation. We can’t always control the first thought that pops into our head, but we can learn to control subsequent thoughts after that.

Unbalanced/Distorted Ways of Thinking

In his book Feeling Good, David Burns (1980) provides a helpful list of the most common distorted thoughts (cognitive distortions) and explains how they create huge problems by undermining self-confidence, increasing anxiety, fostering depression, and putting a strain on relationships. We have provided you with an adapted list reflecting examples related to eating disorders.

Cognitive Distortions

1.  All-or-nothing thinking: This is also known as “black and white” thinking or perfectionist thinking. Intellectually, you know there are shades of gray, but in certain circumstances, intellect and reason go out the window. “One extra cookie means I have to eat the whole box,” and “I am either thin or fat” exemplify this type of extreme thinking.

2.  Over-generalization: A negative event is seen as a pattern, or one mistake means you will not be able to do it right, so you say, for example, “I ate dessert and purged therefore I’ll never get better” or “I overate at the party again. I’ll never have any control.”

3.  Discounting the positives: Accomplishments or compliments are not taken in. Someone says something nice about you but you reject it by minimizing it, or feel undeserving and wave it off as if it is nothing to feel good about. You also might turn praise into expectation and therefore resist compliments.

4.  Emotional reasoning: You believe your feelings make it true. “I feel fat” means, “I am fat.” “I feel hopeless” means, “I am hopeless.” It is hard to separate reality from feelings.

5.  Mind-reading: Thinking you know what others think or will do or how things will turn out, or any number of things that are impossible for you to know. “People envy my ability to control my food” and “Nobody will find me attractive unless I lose weight” are examples of such thoughts.

6.  Personalizing and blaming: Believing that things are always done to you intentionally, blaming rather than taking responsibility or trying to fix the situation. “My mother’s dieting caused my eating disorder.” “He didn’t come to the party because he doesn’t care about me or want to be seen with me.”

7.  Magnification or minimization: Things either matter too much or not enough. “No store has clothes that will ft me,” or “My weight loss is not that bad” are typical thoughts.

8.  Mental filter: You take in all the negative aspects of an experience and filter out the positive. “I stopped bingeing and purging six days this week, but the one day I did binge and purge ruined everything.”

9.  Should statements: You criticize yourself (or others) with “shoulds” and “oughts”, e.g., “I should be able to get better on my own.”

10.  Labeling: Taking on behavior as if it was your identity. “I ate too much,” becomes “I am a failure.” Slipping up on your meal plan becomes “I am a loser.”

When you read through the list of cognitive distortions, do any of them seem familiar? Were you able to see yourself in some of them? It’s helpful to think of your first thought as an “automatic thought” and while some will be healthy and balanced, in times of stress or emotional upset, your automatic thoughts tend to become distorted in often predictable and painful ways. It is important to learn which automatic thoughts you default to so you can begin to recognize when you are trapped in irrational or unhelpful thinking. A single distorted thought can have a cascading effect, intensifying distressing emotions, triggering unhealthy behaviors, and creating difficulties in relationships. The first step in changing or balancing your thinking is learning to recognize when it is distorted. Understanding how this distorted thinking harms you and finding more balanced ways to think will help you feel different and make better decisions in your life and your relationships.

Writing Assignment: Gaining Insight Into Your Distorted Thinking

Look at the list of cognitive distortions and see which ones might apply to you. Make a list of personal examples. Include eating disorder and non-eating disorder examples. For each example, write about how your current way of thinking serves you. What does it protect you from? Does it really work? How does this thinking get in your way?

Personal Reflection:

Gwen: I always felt like I was either a success or a failure, indulgent or lazy, but it never occurred to me that I was a perfectionist. I didn’t realize that never feeling good enough, thinking I wasn’t trying hard enough, or always feeling inadequate were actually the signs of perfectionism. I thought they were indications that I was a failure. I also wasn’t aware that being this way negatively affected my relationships, but it did. A personal experience taught me about my own perfectionism and gave me the impetus I needed to change.

A friend was listening to me criticize myself for getting a B on a paper. I was labeling myself as stupid and a terrible writer. At the same time I was going out of my way to reassure my friend that her B was just fine, good enough, and it definitely didn’t mean anything negative about her. She seemed offended, annoyed, and eventually asked me why I was making this distinction between us. Did I think I was more capable, needed to do better, or should be held to a higher standard than she was? I had been unaware of this paradox in my thinking and didn’t know how to answer her. I felt misunderstood and terribly guilty, but mostly confused. What she could not see, and what I didn’t realize at the time, was that I actually did think I needed to do better than others. It was not because I thought I was better, but rather to make up for something defective deep inside of me that I could not name or explain. What I came to realize was that my belief that I had to be perfect or I was a failure was not only making those around me feel judged, it was also perpetuating my feelings of unworthiness and shame. Inside I had a belief that I was unworthy, so I tried to over-compensate by perfecting parts of myself that were visible to others, as an attempt to guard against others seeing the real me and what I feared was unacceptable. Through careful exploration of my thoughts, feelings, and behaviors I learned I hid behind my perfectionism to protect myself from judgment or rejection from others. The problem with this way of protecting myself was that it prevented me from getting what I truly wanted and desperately needed, which was for others to see and know the real me, flaws and all, and still accept and love me. If I never allowed that to happen, I would never feel truly loved. I had to learn to challenge my thoughts and take risks, one of which was being seen with my imperfections.

Cognitive distortions become entrenched and automatic, even when there is evidence to the contrary that challenges them. Changing your thoughts is a skill that takes effort, but isn’t as hard as it might seem. Even if you have been thinking a certain way for a long time, your brain has the capacity to learn to think differently. New pathways are created each time you counteract a negative, distorted, or extreme thought with a more appropriate or reasonable one. We think of it as being fair and balanced in your thinking and seeing things as a total picture, instead of just seeing the worst of it. Learning how to counteract your cognitive distortions and balance your thinking will help you create a healthy inner life where mistakes are acceptable, failure is part of progress, and confidence grows with experience.

Challenging Your Thoughts and Distortions

Learning to challenge your distorted thoughts before they wreak havoc on your feelings is a crucial skill. In Key 2 we focused specifically on eating disorder thoughts, but most of our clients describe their “eating disorder voice” as becoming a “critical voice” like we described in Key 3 and popping up in many other situations that are not food-related. The voice might be critical, negative, blaming, powerless, or something else entirely, depending on the situation. Using the dialoguing technique described in Key 2 for your distorted thoughts will help you find more balanced ways of thinking in any situation. It’s important to realize that black and white thinking, personalizing, blaming, mind reading, or any of the common cognitive distortions can contribute to your eating disorder in a number of ways. The bad feelings that result from these distorted thoughts often lead to using eating disorder behaviors to cope, so learning to balance your thoughts is a very important skill for life and recovery.

“At some point I realized that my eating was fine, but I kept hearing a critical voice inside bugging me about other things, like I was lazy or not smart enough. I realized that I might always have an inner critic, but I could fight back with the same skills I learned to fight my eating disorder thoughts.”

—AH

The following dialogue is an example of a client combating her automatic thoughts:

Situation: Kevin didn’t call me this weekend.

Automatic Thought: He obviously doesn’t want to be with me. His friends probably told him to blow me off.

Healthy Self: You have no idea why he didn’t call and you are jumping to conclusions. You need to wait and find out the truth of the situation.

Distorted Thought: I am so afraid this means it’s over between us. This has happened to me before. I am so anxious I can’t think of other reasons.

Healthy Self: You have no evidence for that. Although it is possible there is no way you could know that now. You have to do something to calm yourself down and wait for more information.

Distorted Thought (beginning to fade): OK, I know I jump to conclusions; it’s just really hard. I keep telling myself that it is probably the worst case and I know this is my pattern.

Healthy Self: So tell yourself that you no longer are going to jump to conclusions about things but will wait to find out and save your energy to deal with real problems whey they arise. Perhaps you can call Kevin and ask him what is going on.

Distorted Thought (transforming to healthy self): Yes, true. I don’t want to assume things. It is difficult not to feel anxious but I will go for a bike ride and call Kevin later.

Writing Assignment: Dialoguing With Your Distorted Thoughts

Write down some of your automatic, critical, or distorted thoughts. You may already know some of your common ones but if not, a good time to see them clearly is right before or after an upsetting situation. After writing them down begin to challenge them using your healthy self. The goal is to have a full dialogue with your thoughts just as you learned to do in Key 2. Look out for the cognitive distortions and extreme words like “always,” “never,” “everyone,” and “nobody”—they are red fags for distorted thoughts. Rarely are these extreme statements true and if you are honest, you will find a lot of contrary evidence. After writing down and then analyzing the evidence for and against the thought, it is very important to come up with a more balanced way of thinking about the situation. This exercise might seem tedious at first, but our brains are very adaptable and in a short period of time, you will find yourself automatically noticing and challenging your distorted thoughts and dealing with things in a healthier and more balanced way. A client described the process of challenging her thought in this way: “Someone once told me that ‘I am not responsible for my first thought, but I am responsible for my second thought.’ Those few words are mighty powerful and helpful to me. Any time I’d look in the mirror, I’d automatically say something negative about myself. I made a vow that whenever I said anything negative about my looks, personality, or anything, I would—every single time—counter it and say the exact opposite of what I originally said to balance it out. After awhile, I really did start to think more positively, and others noticed this too.”

Your Feelings

Ideally, our feelings are supposed to alert us when something in our life needs attention. Our feelings also give us vital information on how to proceed. If we can connect to our feelings, and understand and accept them, they can help us decide when to make one choice over another, or when to move toward something and when to move away. If you are disconnected from your feelings or are overly emotional, making good decisions is difficult at best, and even unlikely. Young children haven’t fully developed rational thinking abilities yet, so they are good examples of what it looks like when decisions are made from a purely emotional place. A child may want a new puppy but has no idea of all the time, energy, and money that is necessary to care for it. A child may be afraid of monsters under the bed even though he or she is told over and over that there is no such thing as a monster. When you are taken over by your emotions you make choices that don’t seem that rational later once the emotional charge has died down. If you feel angry or sad your feelings can interfere with your ability to make choices. Therefore it is important to recognize and feed your feelings and move past them in order to make good decisions. You feel too guilty or fearful to eat even a bite of ice cream, even though logically you know one bite of ice cream can’t make you fat. Effective problem-solving and healthy decision-making occur when you are able to identify, feel, and then integrate your emotions or feelings with your rational mind or thoughts. When your emotions are high, tapping into that rational space can be challenging, but we are sure you will quickly realize that learning to be patient and allowing the rational thoughts in is a skill worth working on.

Exploring Your Emotions As Signals

Although your emotions serve as signals that something is going on that needs your attention, problems arise when you experience feelings of fear, shame, and anger, signaling that something is wrong, and you react before exploring further. Sometimes your feelings will be based on distorted thoughts: erroneous assumptions, faulty information, or irrational fear. For example, let’s say you expected to receive an invitation to a wedding and everyone else has received their invitation, and yours isn’t in the mailbox. It is understandable that you would feel hurt, sad, and angry if you were purposely excluded from such an occasion. If you immediately act on those feelings when your emotions are running very high, your anger might incite you into an outburst or aggressive action that you would regret and feel embarrassed about if you received your invitation the next day or found out that it was just lost in the mail. Instead of using your feelings as signals to react immediately, try to think of your feelings as signals to investigate further, communicate or reach out for support, and then react or respond in the most effective way.

Feel Your Feelings

As you progress in your recovery, your feelings will become more noticeable and seem more intense. Reconnecting with the myriad of feelings that have been covered up for so long is the reason why getting better often feels worse, at first. Recovery involves learning to feel your feelings associated with all the various stressors that surface in your life, without using your eating disorder or any other way of escaping or masking them. The notion that we are supposed to feel our feelings may sound obvious, but many people, not just those with eating disorders, do all kinds of things to avoid, suppress, or distract from their feelings. People get into trouble with addictions, eating disorders, stealing, self-harm, or a myriad of other behaviors because they have not learned to acknowledge, accept, and tolerate their feelings.

If you are worried about not knowing what you feel, simply stop yourself from engaging in an eating disorder behavior and notice all the feelings that come up. Whatever they are and wherever they came from, a good part of your work will be simply dealing with them.

Writing Assignment: What Feelings Are There

In order to start examining how your eating disorder is serving you, and what feelings are associated with it, make a list of the last few times you engaged in your eating disorder behaviors. List any feelings you were aware of at the time, or which, you now realize, you may have been trying to avoid, distract from, or manage. If you aren’t sure, just list what else was going on at that time. Have you ever been interrupted from engaging in an eating disorder behavior? What were the feelings that came up when you did not get to go through with the behavior?

“Feeling Fat”: Is It Really a Feeling?

Feeling fat is something that plagues people with eating disorders and soon becomes a trigger for all kinds of feelings and behaviors. “I feel fat” is a standard refrain of our clients. Many therapists will say, “Fat isn’t a feeling,” but having had eating disorders ourselves, we remember “feeling” fat and accept it when clients tell us that. Having said that though, we also understand that when therapists or others try to explain that fat is not a feeling, it is because they want you to look further into what other feelings (or thoughts) might also be there lurking under the surface. Sometimes “feeling fat” can be fueled by fear of judgment, moments of self-doubt, shame, or insecurity. We cannot say exactly what lies beneath “feeling fat” for you, but chances are it is a feeling you have a hard time tolerating. People with eating disorders complain of “feeling fat,” regardless of what they weigh, thus corroborating that it can have little or nothing to do with actual weight or size, and more to do with a distorted perception mixed with feelings of anxiety, judgment, or discomfort. If you assume you will stop feeling fat when you lose more weight, or get to the “right” weight, we would argue that is not likely to happen for you if you have an eating disorder. Body dissatisfaction and distortion continues, fueled by the false belief that if you just lose a little more, you will finally feel thin enough, and therefore good enough, worthy, lovable, or whatever insecurity is lurking under your relentless pursuit of weight loss. Many clients report feeling happy, doing well with food, and feeling OK in their bodies, until they get on the scale and see they have gained a few pounds. All of a sudden they feel fat, depressed, unworthy, ashamed, and want to do something to “fix” that feeling. Think about that: why would a number on a scale, or a few pounds, be responsible for all those feelings? This is not how most people normally react, so if you react that way, something else is going on inside that you need to attend to. As long as you believe that changing something on your outside will solve the problem on the inside, these deeper issues will stay hidden and unresolved. We understand the statement, “I feel fat,” but this means a variety of things to a variety of people, and you need to decipher what it means to you. Furthermore, transferring painful and uncomfortable feelings into “feeling fat” can become an automatic process. It feels safer to say, “I feel fat” than it does to say, “I feel lonely” or “I fear I will never find love.”

Writing Assignment: “I Feel Fat”

Think back to the last time you “felt fat.” Write about what was going on right before you had that feeling. What were you doing? Who were you with? What other feelings were you having that you can identify? To see what else might be there, try to replace the word “fat” with any other word such as “angry,” “scared,” or “overwhelmed.”

Understanding and Regulating Feelings

“I realized that I would never achieve what I wanted in life if I continued down the path I had made. I had to learn acceptance and embracing instead of avoiding and pushing away—whether it’s people, food, feelings, or life.”

—SB

Whether you are disconnected from your feelings, or overwhelmed by the intensity when you do feel them, with very few, or possibly no, tools for managing or regulating them, it’s understandable you would try to avoid them. You might react to your feelings in ways that initially seem helpful, but cause more problems in the long run. People with eating disorders will say that avoiding or escaping their feelings through behaviors such as purging or skipping a meal provides temporary relief from feelings that seem intolerable. Eventually, though, the feelings come back. To become a more balanced person and live a full life you need to challenge this thinking, face your issues, and feel your feelings. It can be hard, painful, and scary to actually feel your feelings. There may be many areas in your life where you have repressed your feelings for a long time, but emotional healing takes place when you are able recognize and confront your issues and not use your behaviors to avoid the feelings that arise.

You might not even realize you are using your eating disorder to manage or avoid your feelings on a day-to-day basis. The connection between your eating disorder behaviors and your feelings can be very difficult to detect at first, but will become clearer over time. As your recovery progresses, exploring, accepting, tolerating, and feeling your feelings becomes not only less overwhelming, but rewarding.

Personal Reflections:

Gwen: Feeling vulnerable was the first feeling I realized I couldn’t tolerate, although I didn’t want to admit it, because even thinking about admitting it triggered the very feeling of vulnerability I was afraid of. I did everything I could to keep myself from feeling vulnerable. I was guarded, untrusting, and went out of my way to appear easygoing, fine, and happy all the time. I’m not sure if I even knew what I was afraid would happen if I was vulnerable, but once in awhile when I was not guarded or distracting myself, feelings of sadness, emptiness, and fear would creep in. I would get a glimpse of the lost person I had become in my eating disorder and how alone I felt, and it terrified me.

Instead of acknowledging my fears and vulnerability and reaching out for help, I went back to my eating disorder, which seemed to act as a buffer, a distraction, and a way to keep the focus on the outside, instead of inside, where the problem really was. On the outside, I tried to look like a person who had perfect control over her life. Even when I had some idea my outside appearance had crossed over from “thin and together” to “definitely ill,” I still could not give up the rigid, almost cult-like belief that if I was just thinner, I would feel better. If I didn’t feel good enough, it was because I wasn’t thin enough. I felt so invested in my eating disorder and my belief system, it was hard admitting to myself that I had it all wrong this whole time.

Carolyn: In our therapeutic relationship, Gwen was highly sensitive about the possibility of making me angry, hurting me, or doing anything she thought would make me dislike her. Any strong feelings made her want to escape to avoid any confrontation or any expression of anger, which she feared would hurt people. Gwen needed help realizing that, in reality, it was not her strong feelings or her anger that was a problem, it was the hurt and fear underneath. It was important to help Gwen see that behind her anger was hurt and sadness, and although expressing it would make her feel vulnerable, denying her feelings was driving her to use her eating disorder to cope. I began working with Gwen to help her recognize that her biggest fear was feeling vulnerable in any way and the more intense the feeling, the more vulnerable she felt. I can even remember her cringing when I said she needed to learn how to be “vulnerable,” so we jokingly referred to it as the “V word” from then on. I tried many approaches to help Gwen learn to tolerate vulnerability a little better. I encouraged her to take small risks in expressing herself and staying present, first with me, next her husband, and then her friends. Even though she was very resistant to all of these new experiences, her sense of humor and her drive to succeed proved to be very valuable traits that helped her through.

I also tried to model for Gwen that it is possible for a person to be vulnerable and even emotional, and still hold onto themselves and be strong. Gwen learned what I had learned so many years before her: that feeling her feelings was not only tolerable, but actually helped her be less overwhelmed. For both of us feeling our feelings helped us, both then and now, to live a more authentic and enjoyable life.

Gwen: Learning how to be more open was very difficult, but I tried to take some risks. The hardest part was admitting and talking about things I felt ashamed of. For many years I was not in touch with the shame I had developed about my body, and I forgot how bad it felt and how vulnerable it made me feel. Initially, my eating disorder seemed to be the antidote to my shame. The more weight I lost, the stronger and more confident I felt. As my dieting willpower strengthened, the shame I had been carrying around for so long initially seemed to melt away, along with the pounds. For the first time ever, I felt successful at “controlling myself,” which was intoxicating and even redemptive after so many years of trying and failing to lose weight. Being thin was “evidence” that I was in control of my appetites and protected me from the perceived judgment of others, or so I thought. My shame was redirected into guilty feelings about eating “bad foods” then into eating in front of people, and finally I was unable to even admit when I experienced hunger. I didn’t realize losing weight was just a temporary fix, and my shame was much deeper than my extra weight. Eventually, my eating disorder itself added to my shame. I knew I was living a double life and was terrified people would discover the truth and reject me. I acted confident and put-together, but inside I knew I was fooling everyone and worried that my weak, gluttonous self would be exposed at any moment. In my relentless quest to lose weight, I was chasing acceptableness and betraying myself in the pursuit. The relief of my eating disorder was never enough and never lasted. Eventually, it became impossible to deny reality, and I knew I needed to seek help if I wanted to live. My biggest fear had come to be. I was exposed, vulnerable, and everyone was going to know I had this problem. I could not think of anything that scared me more, and I wanted to run away. Little did I know that at the bottom of that dark center of my shame was the only path to freedom. Admitting I needed help and then accepting the help were both very scary and humbling experiences. I was told that I needed to be nicer to myself, which was a whole new concept to absorb, but how to go about doing it was even more baffling to me. The most helpful discovery I had was when I realized I could use my healthy self/voice to talk back to the critical and even shaming voice inside my head. I learned that when I had a critical thought, I could counter that thought with something kinder. Most of the time what I said back involved accepting I was doing the best that I could, that I was good enough as a mother, wife, and daughter. I started to allow myself to be less than perfect. Even though it took a lot of intention and practice, I could see it was working to reduce my shame in a lasting way. I realized that shame was the flip side of my perfectionism. As I started judging myself less harshly, I was also less afraid of the judgment of others. This came as quite a surprise to me, because I had spent my whole life protecting myself from the judgment of others by judging myself first and more harshly. Feeling my feelings, not judging them, expressing myself, and counteracting my negative thoughts started working, and more and more, I actually started to feel good enough.

Name It To Tame It

People with eating disorders are often confused about or out of touch with what they are feeling. You might have had a hard time identifying your feelings before you even developed an eating disorder, but after you have had an eating disorder for some time, this task is even harder. You might wonder why identifying and talking about your feelings is helpful. From our own personal experience, our work with clients, and from new brain research, we know that when you identify and talk about your feelings it helps you to better control, regulate, tolerate, and diffuse them. Using words to describe your feelings is useful for you if you have trouble knowing what you feel or if you are overwhelmed by your feelings. Very simply put it turns out that by describing your feelings you link and integrate your left (language mode) and right (emotional mode) brain hemispheres. This integration helps balance both emotional dullness and dysregulation creating emotional health and stability. This has been referred to as “Name It To Tame It” (Siegel 2010, pg. 116).

Writing Assignment: “Feelings Journal”

Keeping a feelings journal will help you immensely in identifying your feelings. There are different ways to keep a feelings journal. One way is to just keep a journal with you so you can jot down and describe various feelings you have during the day. Another idea is to get your journal out at night and write about the various feelings you had during the day. Take a moment now to write about a few feelings you have had today, including some that may have arisen from reading this book.

Don’t Judge your feelings

It is important to accept your feelings and not judge them. Feelings arise and they are what they are. Feelings are not good or bad, right or wrong. You feel what you feel. Even if your reasons for feeling a certain way are faulty, the feeling is still there. If someone yells at you and you feel angry inside, but you tell yourself you should not feel angry because “anger is bad,” you will end up dealing with your angry feelings in some other way.

If you label your feelings as being invalid, bad, or unimportant, chances are you will not express them or seek support. Express your feelings, even your feelings about your feelings. In other words, if you are angry but feel bad about it, say that. If you feel jealous, but guilty about feeling jealous, say that. The goal is to become the most transparent you can be. You are not responsible for your feelings, but for what you do with them.

Your Emotions Are Your Body’s Response To Your Thoughts

If your boyfriend is mean to you and calls you a name and you feel angry, that anger is in your body. Your body is responding not just to what your boyfriend said but also to what you think about what he said. For example you might think, What an idiot, I didn’t deserve that. Your body then takes on the energy of that thought and you feel anger. If you had a different thought such as, Oh he was stressed today, I’ll let him have some space and not take what he said personally, then your body would have a different energy. Our body manifests our thoughts into feelings and the emotions that go with them.

It is useful to understand that your feelings and emotions are inside of your body. This knowledge can help you begin to gain separation from your emotions, which leads to being able to regulate them. One way we help our clients grasp this concept is by asking them to change the way they talk about feelings. For example, instead of thinking I am angry, it is more accurate and helpful to say, “I have anger in me.” Saying this might sound awkward and we don’t expect people to go out in the world and talk like that, but we use this phrasing to demonstrate a crucial truth; if you have anger in you, you can figure out how to get it out of you. There are many ways to get anger out of your body: taking time to let it slowly drain out, listening to calming music, going for a run. The important thing is that once you have gotten any intense emotion out of your body, it no longer can take over your ability to think clearly and communicate what you might need or want.

What exactly is your body feeling when you feel anger? Does the word “anger” really describe what is going on inside of you? No! Anger is just a convenient word we all use to label an emotion, but it is not a good description of what our body is really experiencing, or feeling. In fact, there are many feelings associated with anger. Think about when you feel angry. How does your body actually feel? Are your palms sweaty? Do your face and neck feel hot? Does your pulse become elevated? Just the act of noticing and describing the various sensations in your body can help dissipate the anger and calm you down. All the things we are describing will help you to separate yourself from your emotions by identifying the feelings you have in your body. Then you can come up with a way to counteract the feeling. For example, if you feel hot you might have to literally find a way of “cooling off.” Focusing on deep and long breaths will help slow down a fast pulse, or you can do something to discharge the anger, for example one client we know releases anger from her body by practicing martial arts. The goal is learning how to separate from your feelings and emotions and get your body back to neutral. When you can do this, you will be able to resist being overwhelmed or taken over by your feelings. Once you are back to neutral it is easier to think clearly to figure out what you need to say or do. Learning how to identify, describe, and separate yourself from your feelings helps free you from being controlled by or overreacting to them.

Getting the Feelings Out of Your Body: Opposite Action

A good way to reduce the intensity of a feeling and help you get it out of your body is to do the opposite of what your initial and usual urge is telling you to do. “Opposite action” is a term from dialectical behavior therapy (DBT), which is a type of therapy that successfully teaches core skills for regulating difficult emotions in effective ways (Astrachan-Fletcher & Maslar, 2009). It is hard to do opposite action when your emotions are telling you otherwise, but it works extremely well. Opposite actions don’t work well if you are just going through the motions or faking it. You have to really do it with meaning if you want it to be effective. You might need a therapist or someone else to help you decide when to apply opposite action. For example, in a situation where you have a justifiable fear and need to run for your life, it would be foolish to do the opposite such as approaching the situation. Opposite action is meant to help you neutralize your feelings so they are not overwhelming or overshadowing your ability to think clearly.

Examples of Opposite Action

EMOTION	URGE	OPPOSITE ACTION
Anger	attack, yell, lash out to hurt	validate, speak quietly
Fear	avoid, run, scream	approach, do it over and over
Guilt	hide, avoid, isolate	admit, accept, move on
Sadness	shut down, withdraw, isolate	get active, set goals, socialize
Shame	hide, punish keep secret	talk openly, express feelings

Somatic Therapy

Biologically based therapies, also known as somatic therapies, are based upon our understanding of the human nervous system, and how troubling or traumatic experiences disturb the body and the natural rhythm of internal states of well-being. Somatic therapies help you interrupt and reduce or eliminate unpleasant or disturbing emotions and sensations within the body. Somatic therapies focus on body sensations and help you recognize that there are other sensations in the body besides the disturbing ones and how to have more control over your body states. Because our fears are manifested in our body and are often not really about the current situation, or are illogical, trying to get rid of them by using traditional talk therapy is often limited. Imagine a woman who was assaulted or robbed in a parking lot after work. She might become highly anxious when she finds herself in a parking lot, in the dark, or even just alone. No matter how many times you reassure her she is not in danger, she can’t get her body to calm down or believe it. The same is true for people who are reminded of other situations or feelings that were harmful or frightening. Somatic therapy is about teaching you how to tune into your body sensations, and learn how to regulate them. We help our clients develop mindful awareness of their body sensations. We help them notice when their body is out of balance as well as notice positive or neutral sensations that lead to reestablishing natural rhythms of well-being, like expanded, deeper breathing and release of muscle tension. We encourage you to explore this area further and refer you to books in the resource section.

Some Helpful Strategies for Dealing with Your Body Sensations

There are many body-oriented techniques, like body scanning, that can help systematically relax each part of your body. There are body stances you can take which are associated with the feelings you are trying to lessen. For example, if you are afraid, you might notice that your shoulders are very tense and hiked up towards your ears, your breath is short, and your stomach feels like it is in a tight knot. If your body was reacting this way, we might ask you to focus on your breathing and ask you if you want to experiment by changing your body stance. The idea is to put your body in the position it would be in if it was calm. Even if you feel afraid, you can physically lower your shoulders, take deeper and slower breaths, soften and relax your stomach and back muscles, and counteract anything else that your body does when afraid. What happens in the brain when you do this is pretty miraculous. Placing your body in a more relaxed stance kicks in your parasympathetic nervous system, changes your brain, and actually helps your body to calm down. Body therapies are often used when dealing with trauma, or traumatic stress symptoms, but they are useful for learning to tolerate and change sensations and feelings of all kinds.

Sometimes You Just Need Some Self Care

Even though we have devoted much of this book thus far to telling you to face, feel, and express your feelings, we also recognize that sometimes it is useful and kind to have positive self-care methods to help you comfort or distract yourself from the feelings you have. Sometimes you just need a break from things or something to make you feel better. The following are methods and skills we have found useful for our clients and ourselves.

Distraction

Distraction is a very useful coping skill when used appropriately. People often confuse distraction with avoidance, but when you use distraction skills your intention is to distract yourself only if there is nothing else to do about the situation or until you are in a calmer, more rational state of mind. Distraction helps to get your mind off of something that seems to be taking it over, like strong urges or something very upsetting. Urges are feelings and they come and go. For most people, urges tend to dissipate after twenty minutes or so, but it can be a useful experiment to see how long your urges last by timing one. Finding things that truly work to distract you can be a challenge and will take some experimentation. There are literally hundreds of activities that you could try in order to distract yourself, but we will list here only a few ideas.

•  Call a friend.

•  Dance around your living room.

•  Organize or clean something.

•  Volunteer or help someone else.

•  Paint or do an art project.

•  Go out for a meal with someone.

•  Watch a movie or television.

•  Play a video game.

•  Knit.

•  Go shopping.

•  Journal or read.

•  Go for a drive.

Self-Soothing

Self-soothing is another important way to help you cope. Self-soothing consists of finding a way to comfort yourself in times of distress or trouble. It may be easier to self-soothe after you have distracted yourself a bit, especially if your feelings are very intense. Some self-soothing methods can serve as distractions, but often, strong feelings require a distraction that matches the intensity of the emotion for it to be helpful. If you are angry it might be hard to take a bath and relax, but cleaning out the garage might work perfectly. Self-soothing is meant to help relax your body and mind. An effective way to do this is to engage your five senses. Everyone is different, so something that soothes our senses might aggravate yours. Just like with distraction, this takes experimentation and an open mind. As you read through this list of ways to self-soothe through the senses, think about what might work for you and consider trying new things as well.

•  Sense of vision: look at nature or pictures that remind you of places or people you love; look at art; watch a fire in a fireplace.

•  Sense of touch: take a hot bath or shower, get a massage; hug someone who is comforting; pet an animal; put on warm and comfortable pajamas and slippers.

•  Sense of taste: have a cup of your favorite tea or coffee; eat your favorite meal; buy a new favored lip balm.

•  Sense of smell: burn a candle or incense; use a favorite perfume or buy a new one; put fresh flowers in your house.

•  Sense of hearing: listen to soothing music; listen to a meditation CD; listen to a fountain or waterfall.

Creative Assignment: Your Resource Box

Making a resource box is a great assignment to do with a friend or a few friends. Read the assignment over and see if you can find someone who will do this project with you. Get an empty box, for example a shoebox, and decorate it any way you like. You are going to turn this box into a resource box, which will contain items you will need at the moment you find yourself wanting distraction or comfort. Fill the box with things that would be hard for you to go get in the spur of the moment. You will be surprised how grateful you are to have the items readily available. Examples our clients have shared with us include: favorite CDs, a special brand of tea or coffee, a favorite perfume or aromatherapy essential oil, bath foam and great smelling soap, candles (and matches), pen and paper, pictures of loved ones or beautiful places, and special notes from people or favorite quotes.

Additional Assignment

Internet Assignment: Awareness App

We recently learned about a new iPhone app called AWARENESS. For a few dollars, this app gives prompts throughout the day using a gentle “gong” sound, which serves to remind you to record a feeling and what you are doing. This app also leads you in a brief meditative exercise that can be done anywhere and finishes with an inspirational quote related to the feeling you recorded. You can get reports and graphs on your feelings, 20-minute meditations, and much more. Using AWARENESS could be a fun, interesting, and innovative way for you to learn more about your feelings.

Final Thoughts

Hopefully, this key has helped you understand your feelings better and be less afraid of them. We hope you have gained insight into some of your triggers, urges, and subsequent actions, and how your eating disorder helps you and hurts you at the same time. The feelings underneath your symptoms, whether they are part of the cause or what is perpetuating your eating disorder, might not have been obvious or may still not be obvious to you, especially since feelings change and expand over time. Don’t be discouraged if your head is spinning and you are finding all of this overwhelming. Some things need to be read over, talked about, and worked on many times in order for you to fully grasp how it is that you have come to use food or behaviors like bingeing and purging in order to deal with underlying issues and the feelings associated with them. Healing involves learning to cope with your feelings without your eating disorder behaviors, as well as learning to accept your natural healthy body weight and putting food and weight back into their proper perspective in your life. You will not be able to do this without directly dealing with food and weight issues in your day-to-day life. Even though we explained in Key 3 that eating disorders are not about the food, we know we didn’t fool you and you know that on some level they are absolutely about food, and eating, and weight. In the next key we will address your relationship with food and hopefully inspire you to take some risks, begin the process of change, and begin to build not only a better relationship with food, but also with yourself and others.