HAES in Eating Disorders: a conceptual exploration Fiona Willer, Accredited Practising Dietitian Director of Health, Not Diets PhD scholar, QUT
The Non-Diet Approach Body Cues Non-Diet Nutrition All Foods Self Compassion Joyful Movement Body Shape
Translating the non-diet approach into academic research Non-diet Approach principle Academic construct Self Compassion Mindfulness Self Compassion Theory Relational Frame Theory Accept and Embrace Body Cues Dietary Restraint Accept and Embrace All Foods Dietary Quality & Variety Accept and Embrace Body Shape Body Dissatisfaction Weight Control Beliefs Accept and Embrace Movement Physical activity level Enjoyment of PA Accept and Embrace Non-Diet Nutrition Dietary Quality Enjoyment of food and eating
Self compassion is foundational Fostering self compassion allows a strong foundation for nesting non-diet approach practice Self Esteem Self Compassion
What is self compassion? (Neff 2003) Differs from self esteem (which calls for comparison with others) Components Kindness Common Humanity Mindfulness Description Responding to difficult times or difficult emotional states with a spirit of kindness, warmth and love. Seeking to understand the situation rather than judging it harshly. Recognising that pain and imperfection are part of the human experience, a normal part of being alive. Seeking to connect to that sense of the larger human experience when times are tough, rather than feeling isolated and alone in your pain. Observing the internal landscape of thoughts and feelings without becoming overly involved in them.
Self compassion and healthy behaviours More realistic and intrinsically motivated exercise goals (Magnus et al 2010) More likely to seek medical care quickly (Terry et al 2013) Reduces negative affective states (Leary et al 2007) Improves positive affective states (Neff 2003, 2007) Smoking reduction (Kelly et al 2010) Reduced alcohol misuse (Brooks et al 2012) Less risky sexual behavior in people with HIV/AIDS (Rose et al 2014) Proactive attitude towards health, benevolent self talk, motivation towards self-kindness (Terry et al 2013)
Self compassion and disordered eating Less negative reaction to diet-breaking scenario in restrained eaters (Adams and Leary 2007) Fewer binge eating symptoms (Webb and Foreman 2013) Decreased social physique anxiety (Magnus et al 2010) Fewer body image concerns after controlling for self esteem (Wasylkiw et al 2012) Lower self compassion associated with higher eating disorder pathology in ED patients (Kelly et al 2013) Improvement in shape and weight concerns (Albertson 2012) High self compassion associated with low disordered eating behaviours (Geller et al 2015) May moderate the relationship between distress and disordered eating (Geller et al 2015)
CBT vs Mindfulness-based therapies CBT Challenges and labels disruptive thoughts/emotions Cognitive restructuring Assumption of healthy normality (pain and suffering are pathological (wrong/sick/bad) factors that need to be alleviated or avoided) Strategies to avoid pain Behavioural goals set in conjunction with therapist Mindfulness/ACT/DBT Non-judgemental observation of disruptive thoughts/emotions creates distance Disengages from unhelpful thoughts Metacognitive awareness Human suffering is a natural part of the human experience. To expect to avoid all suffering is unrealistic. Suffering is a basic fact of human existence. Learn to accept, tolerate and appreciate emotions/thoughts Self-directed, experimental, experiential learning leading to behaviour change discussed with therapist
Cognitive Behavioural Therapy Mindfulness Harley Therapy 2015
Anorexia Nervosa Non-Diet Approach element/academic construct Self-Compassion (kindness, common humanity, mindfulness) Body Cues/Dietary Restraint All Foods/Dietary Quality and Variety Joyful Movement/Healthful level of physical activity Body Shape/Body Dissatisfaction Non-Diet Nutrition/adequate nourishment Considerations in ED Isolation, secrecy, disconnection, shielding vulnerability Severe restraint, body cue perception changes Narrow diet, food fears Sometimes obsessive, compensatory, fear driven Persistent over-concern, body checking Inadequate energy intake, high risk of deficiencies?appropriate Elements already present in treatment Not appropriate until malnutrition corrected and well on the way to recovery Stepped/scaffold approach already present in treatment Avoid trigger forms of exercise, try new, non-measurable movement, dependant on malnutrition status Already part of treatment Self directed nourishment only when well on the way to recovery and malnutrition corrected
Bulimia Nervosa Non-Diet Approach element/academic construct Self-Compassion (kindness, common humanity, mindfulness) Body Cues/Dietary Restraint All Foods/Dietary Quality and Variety Joyful Movement/Healthful level of physical activity Body Shape/Body Dissatisfaction Non-Diet Nutrition/adequate nourishment Considerations in ED Isolation, secrecy, disconnection, shielding vulnerability Severe restraint then disinhibition, body cue perception changes Narrow diet, food fears during restriction Sometimes obsessive, compensatory, fear driven Persistent over-concern, body checking Deficiencies will vary depending on compensatory methods?appropriate Elements already present in treatment Not appropriate until any malnutrition corrected. Use clinical judgment. Stepped/scaffold approach already present in treatment Avoid trigger forms of exercise, try new, non-measurable movement, dependant on malnutrition status Already part of treatment Self directed nourishment only when food fear has diminished considerably
Binge Eating Disorder Often coexists with overweight/obesity The risks cited for BED are those associated with weight status, not specific to BED Trying to kill two birds with one stone when birds are flying in opposite directions ED treatment: normalise eating patterns (flexibility, satiation etc) Weight focus: restrict intake to lose weight (inflexible, denies physical cues etc) If the ED is so important in AN and BN, why is it not prioritised in BED? Why does the weight I happen to be at presentation make any difference to helping me with my thoughts and behaviours? (answer: societal prejudice)
Binge Eating Disorder Non-Diet Approach element/academic construct Self-Compassion (kindness, common humanity, mindfulness) Body Cues/Dietary Restraint All Foods/Dietary Quality and Variety Joyful Movement/Healthful level of physical activity Body Shape/Body Dissatisfaction Non-Diet Nutrition/adequate nourishment Considerations in ED Isolation, secrecy, disconnection, shielding vulnerability, shame May feel disconnected from body cues Narrow perception of healthy diet, food fears, varies Sometimes compensatory, fear driven, or not present, varies Overweight/obesity may be seen as problem by pt and therapist Varies Appropriate Appropriate?appropriate Appropriate with initial scaffold approach if eating chaotic Appropriate - avoid trigger forms of exercise, try new, non-measurable movement if willing Appropriate Appropriate - self directed nourishment once comfortable around all foods
Binge Eating Disorder Non-Diet Approach element/academic construct Self-Compassion (kindness, common humanity, mindfulness) Body Cues/Dietary Restraint All Foods/Dietary Quality and Variety Joyful Movement/Healthful level of physical activity Body Shape/Body Dissatisfaction Non-Diet Nutrition/adequate nourishment Considerations in ED Isolation, secrecy, disconnection, shielding vulnerability, shame May feel disconnected from body cues Narrow perception of healthy diet, food fears, varies Sometimes compensatory, fear driven, or not present, varies Overweight/obesity may be seen as problem by pt and therapist Varies Appropriate Appropriate?appropriate Appropriate with initial scaffold approach if eating chaotic Appropriate - avoid trigger forms of exercise, try new, non-measurable movement if willing Appropriate Appropriate - self directed nourishment once comfortable around all foods
Translating HAES into clinical practice: www.healthnotdiets.com