Janean Anderson, Ph.D., CEDS, joined us for an interview on her book, Recover Your Perspective: A Guide to Understanding Your Eating Disorder and Creating Recovery Using CBT, DBT, and ACT. What follows are our questions in italics and her thoughtful responses.
Recovered from your own eating disorder, you note, “… having an eating disorder causes you to lose your perspective, the perspective of your true self, who you really are.” This very rich statement holds a lot to take in. Can you please share a bit of your insight?
When you have an eating disorder, at some point the disorder becomes bigger than you are. People can experience this in all sorts of ways. For me, I knew I had lost connection with who I was during my eating disorder because nearly all my thoughts were eating disorder thoughts; obsessing about calories, ruminating on my hatred of my body, etc. Things that I normally thought about, and felt about, were pushed to the side, especially my relationships. The eating disorder was the center of my world. It took up most of the space in my mind and my heart for a lot of years.
In your chapters focused on Cognitive Behavioral Therapy (CBT), you point out the thought distortion of “discounting the positive.” How does this come into play via the sabotage of an eating disorder?
Understanding how eating disorders discount the positive is crucial in eating disorder recovery. Eating disorders can take a long time from which to recover and the recovery process is exhausting. So, if you never take stock of all the forward movement you’ve made, you’re more likely to continue feeling stuck in the eating disorder. If you feel stuck, discouraged—any “negative” emotion really—it’s fodder for the ED. The ED will even cause people to use behaviors because they’re upset about their progress in recovery!
In my work with clients, I always felt “should” statements had the capacity to turn people’s experience into a composite of guilt, obligation, inadequacy, and self-loathing. Your thoughts?
I wholeheartedly agree! Should statements, to me, are normal “shoulds” taken way too far. Yes, you should follow the law, you should be kind to people, you should show up to work as expected. However, eating disorders put really large, guilt-inducing “shoulds” on things that don’t matter much. The hard part is that because should statements produce guilt, the person has to work through these unnecessary feelings of guilt. Guilt can be tricky too because guilt is immobilizing—it’s easy to get stuck in guilt.
Referencing the significance of Dialectical Behavior Therapy (DBT) in eating disorder recovery, emotional regulation is a useful skill. Please share an example illustrating the shift from an emotionally dysregulated food episode to a more stable state.
With emotional dysregulation I like to emphasize a couple of points with the people I work with. 1) Emotional dysregulation means you’re very upset, not a little upset. 2) You’re so upset that in order to get rid of those intensely uncomfortable feelings, you are likely to act more impulsively than you would normally. When emotionally dysregulated around mealtime, you may have just received upsetting news at work or just had an argument with your partner. You feel whatever uncomfortable emotion, anger, sadness, frustration, shame, whatever. Then, you head to the kitchen and binge. Or, you impulsively decide to cancel dinner plans or toss out the food you were going to eat and restrict instead. In the same situation, to gain some emotional regulation, you may have experienced the same stressors but you recognize that your emotions are all topsy-turvy. This is a great time to slow down. Take deep breaths. Do any self-soothing exercises that you like. You could even ask for support from someone while those emotions lessen in intensity. Once those emotions feel less intense and you don‘t feel the urge to act on impulse, you can approach food with mindful compassion.
Please offer some ways DBT can improve interpersonal effectiveness during and after recovery.
Interpersonal effectiveness is key in eating disorder recovery and beyond. During recovery, one of the primary ways this operates for people is in learning how to assertively communicate their needs. Eating disorders can help people communicate their needs – when you are sick, people are more likely to notice and offer support. Interpersonal effectiveness helps people ask for what they need without using the eating disorder. After recovery especially, interpersonal effectiveness is helpful for evaluating whether a relationship is meeting your needs or not. If not, it might be time to move on to other relationships that can get you what you’re looking for.
Acceptance and Commitment Therapy (ACT) improves “Psychological flexibility.” One effective process associated with ACT is understood as connecting with one’s values. How does an eating disorder challenge and cloud staying connected to one’s values?
I love doing values work with my clients! The way I explain values work in the ED recovery process is by exploring how the ED has its own agenda. Eating disorders want to keep themselves going, they never value your health, they don’t care if they get in the way of your relationships, career, family life, and eating disorders are no fun! I like to talk with clients about the things that made them feel lit up inside before the ED started running the show. In my experience, most people do value their health and relationships deeply. Moreover, they hold other values dear as well – such as freedom, fun, honesty, and kindness. The eating disorder doesn’t line up with those. For example, if you truly value kindness but internally your ED is berating you with nonstop, mean thoughts about your weight, those things don’t go together. You, authentic you, care about kindness. The eating disorder does not.
You conclude recover your perspective: A Guide to Understanding Your Eating Disorder and Creating Recovery Using CBT, DBT, and ACT with a message of hope. How did you find your hope during your recovery?
I chuckled with this question because my clients often tease me about how I “geek out” about recovery and have so much hope for people. I should start by saying there were many times during my eating disorder, and during the time I was trying to recover, where I felt truly hopeless. But, I think hope is one of those things that if you do anything, any little thing to nourish it, amazing things will grow. I made sure to keep track of the progress I was making. I’d think, “Oh, I hated myself a little less today? YES!”
Another skill that was helpful was breaking down the idea of recovery into each little decision. Recovery as a concept felt completely overwhelming. But, I knew what would be best at the next meal, or snack, or conversation with a friend, or what my therapist suggested for homework. If you continue to do the next right thing, you’ll ultimately end up in the right place.
About the author:
Janean Anderson, Ph.D., CEDS-S Janean Anderson, Ph.D., CEDS, is a licensed psychologist and author. She is the host of The Eating Disorder Recovery Podcast, an internationally renowned podcast and leading podcast in the eating disorder treatment field. She is a Certified Eating Disorders Specialist (CEDS-S) through the International Association of Eating Disorder Professionals (iaedp) and iaedp Approved Supervisor. She is the Founder and Director of Colorado Therapy & Assessment Center, an outpatient treatment center in Denver, CO specializing in eating disorders. Recovered herself from an eating disorder, Dr. Anderson wholeheartedly believes recovery is possible.