Embodiment and the Treatment of Eating Disorders: The Body As a Resource in Recovery Interview

Catherine Cook-Cottone, PhD, joined us for an interview on her book, Embodiment and the Treatment of Eating Disorders: The Body As a Resource in Recovery. What follows are our questions in italics and her thoughtful responses.

You view embodiment as a basic human right. Please tell us more.

I have spent several years doing mindfulness and yoga consultation with the United Nations Foundation in support of humanitarian workers and their wellbeing. In doing this work, I immersed myself in the Universal Declaration of Human Rights which were written after the horrors of World War II. There are 30 articles that are explicated. At their core, each human right is based on an individual’s ability to be positively embodied – these include being free, equal, self-governing, and having security of person. It also means you are free from cruelty and inhuman or degrading treatment or punishment. The final article declares that no one has the right to take away these human rights.

That last one resonates so strongly with me. We assume this is true of course. We think, “Absolutely! No one should take away another’s rights!” We find those who violate this truth to be problematic, concerning, and wrong. Yet, so often, for those of us who are privileged enough to live a life that allows us to live out these rights, we so handily and without pause give away our own experiences of positive embodiment—the central feature of all human rights.

We don’t question algorithms drawing us into our phones and computers and away from our relationships and life experiences. We internalize media messages about our bodies, our relationships, our value without interrogation. We diet and starve ourselves because of a cultural belief that weight loss will lead to acceptance and happiness. Every day, most of us fail to consider how we have disregarded the human rights for which so many have fought and died.

I think of eating disorder prevention in these terms. Prevention means changing the narrative, the ethos that there are such things as perfection, ideal bodies, perfectly managed emotional experiences or lives without failure and disappointment.  Prevention is about living into who you are, as a rich and embodied experience of figuring it out at your own pace. When I work with patients struggling with disordered eating, I ask them to join me in a fight for their right to be embodied, their right to live a self-determined life, free of the pain that accompanies the oppressive experience of living with disordered eating. It is something I am very passionate about. For more see Chapters 1 and 2.

In the context of “the body as a resource,” what is the difference between I know and I can?

I love this question. Over the 15 years I have been in private practice, I have worked with many patients who feel at home in “I know” and are terrified to know if they can. Intellectualization is a key defense mechanism for many who struggle with disordered eating. It is far away from the body and nestled in the safety of thinking and understanding. I have had patients who know far more than I do about the human body either as medical doctors, nutritionists, or physical therapists, yet they are afraid to be in and of their bodies – in the deeply felt “I can try” of life.

The word “can” is fascinating. Simply put, it is a container that holds things. It also means to be able, permitted, or have the possibility to. It means that you know how and you are able to do it. To know you can do something, means you are out there trying, perhaps failing, and maybe sometimes getting it right. It is embodied action. You are the holder of ability, you have given yourself permission to try, and you are filled with possibility. “Can” is one of my all-time favorite words.

I work with patients getting to the consideration that they can try. They might struggle at first to be with a feeling. It is not an easy thing – being with. And they can try – feet grounded, deep belly breaths, and allow the feeling to be and move. Maybe today, we just get to the feet grounded part – good. That is, “I can.” And from there, in time, we get to “I can recover.” For more see Chapter 4.

What are some of the ways an individual can move through and beyond eating disorder recovery by asking “Why”?

This is an important part of the book and positive embodiment. In many therapies, we don’t ask the patients about meaning in life or a sense of purpose (their “Why?”) until the later stages, if at all. Our work studying trauma, eating disorders, and stress suggests that those who have a good sense of their “Why?” have what we call “Mindful Grit.” It is not the classic grit that highlights perseverance and sticking to goals. Many of my patients with eating disorders use that type of grit to fuel their disorder. Mindful grit asks patients to consider self-compassion and to turn toward a sense of meaning and purpose when things get tough.

Some patients, or their caregivers, assert that they do not, perhaps could not know the answers to the questions about meaning and purpose. It is important to make a distinction between asking and knowing. Asking “Why?” does not mean you need to know – it means you can start living the question, allowing for inquiry about what matters to be part of the dialogue.

I often think of disordered eating as, in part, a displacement of meaning. Calories, pounds, mistakes, self-perceived failures and vulnerabilities take up all the space and are given tremendous meaning. Accordingly, early in treatment, I start asking about values, what is really important.  The goal is the shift meaning and purpose away from calories and pounds and toward the stuff that makes life good. For more see Chapters 5 and 8.

When an individual diagnosed with an eating disorder is first introduced to the Mindful Self-Care Process, how might they react?

Mindful self-care is a step-by-step actionable process of taking care of the self. It is important to make a distinction between the commercialized notion of self-care and mindful self-care. This is not about getting a massage once a week or your nails done, although those things can be nice. Mindful self-care is a noticing of your feelings, thoughts, actions, and even relationships and working spaces and how these domains of your life nourish and support you.

There are barriers. Some patients struggle with self-worth or shame and feel they do not deserve self-care. Others are lost in achievement drives or a notion of rigid perfectionism that considers all self-care indulgent. This is why self-compassion is a component of mindful self-care and a good place to start for those who find nourishing the self painful or frightening. See more in Chapter 7.

Please share some steps one can take to learn to listen to their body.

My favorite it very simple. Sit or lie down in a place where you feel comfortable. Close your eyes or soften your gaze. Place one hand on our belly and one hand on your heart. Begin by noticing your breath, breathing in and breathing out. Perhaps you notice your hands rising and falling with the breath as it moves in and out. Pause here and notice. Next, softening the breath, orient our attention to your heartbeat. You might notice your heartbeat inside or feel it under your hand or both. Simply notice. It might seem too simple to matter, yet getting good at this is foundational to knowing when our body feels safe, scared, happy, calm, and more. This is also a wonderful first step for simply being with and connecting to your body. If you want to add a bit more, you might even say to your heart, “I am here” as you breathe and notice. “I am here.” For more see Chapter 9.

Communities may misinform and promote negative practices for embodiment. Can you please mention some of these themes?

It can happen in almost any community or family. Here are a few themes that can get in the way of positive embodiment:

  • Negative body talk regarding shape, size, or ability.
  • No pain, no gain. Ignore the signals your body is sending.
  • Winning is more important that your own embodiment, health, the team, and/or team members.
  • Focus on the weight loss and body shaping/sculpting outcomes over the experience of being with your body.
  • Modifying is weak or unskilled.
  • We only sell smalls and medium size clothing here.
  • The longer, harder, more intense your work out the better, always.
  • For more see Chapter 10.

Do you ever wonder what would be different if you hadn’t connected with yoga?

Yes – I was just saying that this morning!

Yoga and mindfulness do not keep life’s challenges away. Life can be hard, even harder in our current reality – whether or not you meditate or do yoga.

The gift of these practices is, if I notice, ground my feet and breathe and take a pause, I won’t be the one to make things worse. More, as I practice being in and of my body, through it all, life shifts from something happening to me, to something happening for and through me.

It’s a practice, one that lasts your whole life. The goal is not to get perfect at it one day. It’s a remembering that your body is you and that really living means lovingly inhabiting your body just as it is each moment of each day.

About the author:

Catherine Cook-Cottone, Ph.D., is a Licensed Psychologist, Registered Yoga Teacher, and Professor at SUNY at Buffalo. She is creator and director of the Mindful Counseling Advanced Certificate program and co-founder and president of Yogis in Service, Inc. a not-for-profit organization that creates access to yoga.

Catherine’s research specializes in embodied self- regulation (i.e., yoga, mindfulness, and mindful self-care) and psychosocial disorders (e.g., eating disorders, substance use, and trauma). Her research has been funded by the National Science Foundation, UNICEF, lululemon athletic, and the Give Back Yoga Foundation. Catherine has written eight books and over 75 peer reviewed articles and book chapters.

Her international work includes research and consulting with the Africa Yoga project and the United Nations Foundation helping develop and deliver a trauma-informed, mindfulness-based resilience training for yoga teachers in Kenya, Somalia, and Rwanda and humanitarian workers in North America, Africa, and the Middle East. She teaches courses in psychopathology, mindful therapy, yoga for health and healing, self-care and service, and counseling with children and adolescents. In 2018, she was awarded the American Psychological Association’s Citizen Psychologist Presidential Citation.

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