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Once I learned that as a graduate student in psychology, I would be forced to take at least two semesters of statistics courses, it suddenly became my prerogative to figure out how minimize this trauma. When I was interviewing for various programs, I would ask the current students about their experience in the class, the professor, the rigors and challenges.

“Don’t you want to know how many graduates get jobs or if we feel respected by our faculty?”

“No, I just need to know if I have chance in hell of passing that stats class. Thanks.”

A surprise ending

For all of my whining and foreboding, I turned out to not be a half-bad amateur statistician. And while I would never profess any kind of love for this mathematical science, I can honestly (and with a straight face) say that I’ve come to appreciate my statistic training immensely.

Why? Well, I’ve oddly discovered that I enjoy research. And while conducting studies isn’t currently a major part of my work, I find myself using research constantly. And beyond that, I can now easily see through the loads of statistical crap thrown at me in the media.

Being able to apply a critical eye to what we hear, see, and read makes us smarter consumers and can prevents us from getting totally duped. Or unnecessarily panicked, as is often the case.

Facebook causes eating disorders?

Take for example, the claim that spread like wildfire mid-last year. Headlines around the globe touted, “Facebook causes eating disorders.” In The Register article posted online, the headline was followed by the first line, “A survey carried out in Israel shows that the more time young girls spend on Facebook the more likely they are to develop an eating disorder.”

So what you’re telling me then is that Facebook does NOT cause eating disorders?

This is an example of likely the most common error the media makes in reporting research. They report correlation as causation. Here’s a primer: Correlation means that two things (Facebook usage and eating disorders, in this case) are related in some way. When there is a positive correlation, as the rate of one increases (time on Facebook), the rate of the other increases (eating disorders).

But take this classic example to see why this does not mean that one causes the other. Researchers have found a positive correlation between ice cream sales and murders in a small town (really, I’m serious). Does that mean that ice cream causes murder? Are there enraged lactose-intolerant violent criminals out there who just can’t handle their sundae and turn into predators? Simply, no. In this case, researchers suspect that there’s actually a third variable that contributes to both of these – high temperatures. But if we’re not measuring that third variable, we get lost in believing that our Rocky Road is jail bait.

Chicken or the egg?

For those of you who are curious, the Facebook study looked at 248 Israeli girls’ media habits and eating issues. The problem is that this correlation does not reveal which direction the relationship goes. Meaning, it could be (and it would be my contention, to go out on a limb here) that girls who have or are likely to develop eating disorders spend more time on Facebook, rather than the reverse (that they “catch” eating disorders by being on Facebook). It makes much more intuitive sense that girls who are more focused on image, concerned about body weight and shape, possibly somewhat isolated (i.e. girls with risk factors for eating disorders) would spend more time on social networking sites. And sometimes intuition is just as important as hard data.

Generalizing schmeneralizing

So say a study actually does involve experimental conditions, meaning it can point us to causation. Does that mean that the results are going to be true for all of us? Absolutely not. As you probably know, the majority of studies are conducted using participants from the college campuses where the researchers work, meaning that the sample is quite often college students. Not only does this mean that the participants are usually of a certain age range (18-23), but they also disproportionately represent a certain segment of the population – those that go to college. While some diversity exists, we can reasonable conclude that certain segments are going to be underrepresented, such as the poor, the illiterate, racial and ethnic minorities, and people following Bill Gates lead.

It’s also important to consider where the study is being conducted, meaning what geographic area. If the study took place in Israel or Poland or Texas, it makes a difference. Even subtle things that one wouldn’t assume would depend on location (e.g. genetically determined variables) can be impacted.

The point is, you have to know who exactly the study was looking at and where before assuming that it applies to you.

What are you telling me, really?

Yet another question to ask ourselves in this confusing web of statistics reporting is: Is any of this really meaningful? And, further, is it useful to me personally?

I read an article recently claiming, “Soy doesn’t boost brain power in older women, says study.” Okay… I’m not exactly sure my life was enhanced by knowing this fact. It doesn’t make me want to kick my tofu to the curb (it didn’t say it lessens brain power, after all). You have to consider how meaningful the statistics really are, because before you know it you become that 8%* who spout totally useless information just to sound smart. (*Disclaimer: I made that up.)

And more importantly, statistics often don’t mean a whole lot when it comes down to your individual life. Take the recent study that claims that delivering a baby via cesarean section increases the chances of the child being obese by age three. Last time I asked any woman delivering her child, she wasn’t making the decision to deliver vaginally versus a c-section based on her child’s future penchant for Capri Suns. In fact, she wasn’t basing it on anything other than what her doctor and she decided was best for her and the child (let’s be honest, usually the child) in that moment. No woman I know who’s had a c-section made the decision lightly, and research like this, though potentially valuable in certain ways, isn’t useful when it’s directed at mothers who already feel guilty for just about every little thing they do. Because, after all, mothers are to blame for everything, right?

The bottom line

The bottom line is that you have to be careful when interpreting statistics, and even more careful when deciding how much stock to place in them. Because, honestly, when it comes down to it, when you learn you have a 10% chance of getting an illness, and then you get it, your chance just went to 100%. And that’s all that really matters.

{image credit :: jeredb}

Eating disorders are serious, life-threatening mental and physical illnesses. I repeat: Eating disorders are serious, life-threatening mental and physical illnesses.

Got it?

With all of the tireless advocacy work that organizations around the globe are doing, I am hopeful that this message is being transmitted. Being tuned in to the efforts of such organizations as NEDA, ANAD, Generation Mirror, Eating Disorder Network of Maryland, and more, I see champions of this cause fighting endlessly to spread awareness about these disorders.

But we’re not there yet.

Myths about eating disorders abound. Perhaps most prevalent is the notion that eating disorders only impact young, white females, and that they are disorders of vanity. People won’t say this, at least not often and typically not to my face, but I see the vestiges of these old beliefs everywhere – insurance companies that won’t recognize eating disorders as the potentially fatal medial conditions that they are, tee-shirts sold by major retailers that paint eating disorders as a fashion statement, and even eating disorder campaigns that focus solely on a small segment of those affected.

Again, I am hopeful that the tides are turning and that reality of these illnesses are becoming more apparent. Today, over half of Americans know someone with or have an eating disorder. To be a better parent, co-worker, cousin, son, or friend, shouldn’t we know the truth?

Here are five of the lesser talked about myths that I come across regularly:

MYTH: Eating disorder treatment is too expensive and insurance won’t help.

FACT: The best eating disorder treatment is individualized and often includes a combination of psychotherapy, nutritional therapy, medical monitoring, and other types of treatment (such as family therapy, expressive therapies, and more). The cost of such treatment varies somewhat by such factors as geographic location, the licensure of the clinicians, and the availability of services in an area. However, treatment for an eating disorder is vital for full recovery, and most treatment centers will work with an individual to help them get the services that they need. While we often hear tragic stories of insurance companies denying payment, there are many insurance companies who do regularly pay for treatment, especially at lower levels of care (e.g. intensive outpatient services). The only way to know whether your insurance company will cover treatment is to speak with them directly. One’s doctors and other providers can also advocate for payment, and there are also actions one can take to appeal a decision of an insurance company. To learn more about this, visit NEDA’s page.

MYTH: Eating disorders are caused by bad parenting.

FACT: People with eating disorders often have difficult relationships with family. People without eating disorders also often have difficult relationships with family. While history has been full of accounts of how narcissistic, hypercritical, and unloving parents have pushed their children into eating disorders, today most experts agree that parents do not cause eating disorders. This is not to say that familial influence does not play a role in the way that an eating disorder is expressed, but we also know that the development of an eating disorder is multi-faceted. It involves a complex combination of genetic predisposition, temperament, learning, stress, and more. In fact, most individuals rely on their families for support during a battle with an eating disorder, and family can be one’s biggest champion.

MYTH: People who binge eat just need willpower.

FACT: Binge eating is part of both Bulimia Nervosa and Binge Eating Disorder, and is also often a part of other disorders as well. Binge eating can occur in response to a period of restricting food intake, emotional stress, or for other reasons. It does not, however, occur in response to a lack of willpower. Individuals who struggle with binging are from every age, gender, ethnic group, sexual orientation, and faith. They are also of every size, shape, and weight, and it’s not possible to tell whether someone has this issue by looking and him or her. You also cannot tell how much of this mythical “willpower” that an individual possesses simply by looking at what they eat. Binge eating is a serious and often very distressing issue, and one that requires both compassion and persistence to treat effectively.

MYTH: Everyone who has an eating disorder has been abused.

FACT: While our intuition or even clinical experience tells us that those individuals with eating disorders are more likely to have experienced trauma, research generally does not support this. Data usually shows that approximately 50% of the population have experienced trauma, a number that also holds true among individuals with eating disorders. Trauma can be a somewhat subjective idea, however, and the impact of events can differ greatly among individuals depending on many factors — age, supports, and resiliency, to name a few. When a trauma has occurred and is determined to be entwined with an eating disorder, it is often the case that an individual will need to address this as part of their treatment.

MYTH: To recover from an eating disorder, one just needs to start eating normally.

FACT: If only this were the case… Too many individuals have been told this by loved ones who they themselves were desperate for a way to help the person suffering. While developing “normal eating”, as defined by eating an amount appropriate to provide necessary calories and nutrients, is a vital part of the recovery process, it is not the only part. Individuals in recovery often have to start by recognizing their disordered eating patterns and even develop a sense of what normalized eating is. For some, eating issues have been part of their lives since being a young child and they have only a vague idea of what constitutes a healthy meal. Eating disorder treatment also often involves other important components, like developing alternative means of expressing one’s self, building self-esteem, andreconnecting with relationships.

For more myths, and the truth behind them, check out Generation Mirror.

What eating disorder myths have you heard?

{image via pinterest; originally found at The Quilted Castle}

Despite having been one half of hundreds of therapeutic relationships over the years, I work hard to remember that for many individuals who sit down in my office, this could be the first time that they’ve entered into this experience.

I recognize that making the decision to go to therapy isn’t an easy one. It usually comes on the heels of deciding that something significant in one’s life isn’t working as she thought it should. Sometimes what isn’t working is incredibly profound, and touches nearly all aspects of her life. Or it may seem on the surface to be minor, trivial even – but hits on such valued parts of an individual’s life so as to push them into my office. Whatever the reason that someone decides to enter treatment, it’s a big decision and one that is never taken lightly.

So if you’re that person – you’ve decided to allow a trusted professional to help you make important changes in your life – you might want to know what to expect. While sitting down in a stranger’s chair is never easy, per se, being armed with an understanding of the process is key to developing the trust that is vital to the process.

Here’s what you can – and should – expect when starting therapy:

1. You’ll be asked why you’re there. It may sound obvious, but the therapist will want to get a thorough understanding of what brings you to treatment. Even if you’ve alluded to “relationship issues” on the phone, he will want to hear in your own words (and in more detail) how you think about the problem, and why you’ve chosen to get help now. Even if you think that certain parts are irrelevant, share them. It helps the therapist to help you if he has a richer context in which to understand the issue that concerns you.

2. You’ll be told about your rights as a patient. The therapist will spend some time letting you know about what you can expect from her and the process of therapy. She’ll likely explain that you can expect your information to remain confidential and secure, unless you are at risk of seriously hurting yourself or someone else. She should generally also let you know things like her fees, cancellation policy, how you can access your records, and more. The specifics will be based on the laws of your area and the specifics of her profession.

3. You’ll learn about the nature of the therapy relationship. The therapeutic relationship is quite different than other relationships that we are used to. When you think about it, it can actually seem a little strange. You’re pouring your heart out to a person who just met you recently and you know nothing about. But certain therapeutic boundaries are in place for a reason. You should be able to trust that you will not have to take care of your therapist’s needs and feelings. You’ll learn, likely quickly, what your therapist’s style is when it comes to this. Some may disclose some personal information about themselves, and you’ll need to decide what you feel comfortable with.

4. You’ll learn about the therapist’s approach. There are more styles and approaches of therapy than we could possibly discuss here, but they often fall along a continuum of directiveness. Some therapists will take a more active approach, asking you to do things like monitor and challenge thoughts and feelings and experiment with changing your behavior. Others will spend time helping you to develop insight into your patterns of functioning and work to provide a new relationship experience via the therapy itself. Others will do a bit of both. While it’s not always important to know precisely how things are working (in fact, it can sometimes steer you off course to get caught up in the details), you should check in with yourself to determine how comfortable you are with the therapist’s style.

5. You’ll be invited to ask your own questions. I encourage you to use this space to really be a savvy consumer. Questions that can be helpful to ask include: What kind of license do you have to practice? Do you have a supervisor or will you be consulting about my case? Have you worked with others who have my issue? What can I expect from therapy? Can I call you between sessions if I need to? How will I know if things are improving? If the therapist avoids these questions or doesn’t give you the answers you are looking for, I suggest proceeding cautiously.

It’s important to remember that the effectiveness of therapy is based heavily (very heavily, in fact) on the therapeutic relationship, so it’s vital to feel a good fit is in place. If you don’t initially, however, that might not mean the therapist isn’t for you; it could mean that you need to give the process time. Unless there is a significant issue, I always encourage patients to give a therapy relationship at least a few weeks for trust and rapport to develop. If these things don’t happen, I urge you to seek a therapist who will meet your needs. Remember, this is your treatment and your mental health.

If you’ve been to therapy, what has your experience been like? What would you ask a new therapist?

{photo credit :: lady madonna}

Had you asked me a couple of years ago whether I thought the internet was a vehicle for recovery, I likely would have laughed (and not an “Of course!” kind of laugh). Like many mental health professionals, I had learned to be leery of this mysterious entity that existed outside of the safety of our walls.

The little that I knew revolved around the dangerous and provocative world of pro-ana and pro-mia websites. And my understanding of the internet’s potential in promoting health was limited to WedMD and Wikipedia. Yikes.

It’s sad to think about just how much I was missing! As I started my own blog and began to dig into the multiple layers of the online world, I quickly discovered just what a powerful tool social media could be for those in recovery.

Really, it makes perfect sense. Blogging about one’s journey is similar to keeping a journal – a practice I highly recommend to nearly all of my patients – and sharing it with a community that can give heartfelt feedback and support (I know it’s not all rainbows and daisies, however – read on for more on that!). And we now recognize the power that writing about our experiences can have.

Dr. James Pennebaker knows this well. He’s spent the many years of his life researching the power of the pen – or the keyboard. In numerous studies, Pennebaker has demonstrated that writing about our experiences is healing – and not just in a subjective, “I feel free!” sense, but in very real and measurable ways.

Pennebaker has found that focused writing has helped individuals with issues varying from terminal illness to life transitions. The people in his studies that engaged in meaningful writing came down with fewer illnesses, needed less medical care, had less depression, and reported having better work performance.

And how is that possible, you wonder? Part of the reason that blogging can be so powerful is that it combats the isolation and secrecy in which many of our diseases and difficulties breed. As I’ve said before, we’re as sick as our secrets, and thus emerging from this seclusion can be incredible healing.

But if you’re thinking about starting a blog as a means of promoting your development or recovery, there a several things to keep in mind as you get started. Here are a few of them:

• Create meaning when you can. Besides pulling us out of isolation, blogging – like writing itself – can be powerful by helping us to make sense of events and experiences that can feel like they have no reason or meaning. In Pennebaker’s studies, he encouraged participants to not just write, but to explore the thoughts and emotions surrounding the events. He wanted participants to tie things together for themselves, part of a practice we sometimes call meaning-making, and found that those who did benefited the most.
• Be willing to change your tune. Sometimes the public nature and finality of hitting publish can feel like a major commitment. We can start to feel like putting a feeling, an idea, or a promise out there into cyberspace means that we have to continue down that path as far as it will take us. However, it’s important to have the flexibility to be wrong. Just because you once said that distracting yourself with Sudoku was the key to freeing yourself from emotional eating doesn’t mean that you can’t change your mind later on. To me, the best blogs are authentic ones.
• Only share as much as you are comfortable. Just because you started a blog and have a devoted following of readers doesn’t mean that you owe anyone more than you’re ready to share. Some individuals use blogs as a means of holding themselves accountable (such as when the lapse into a behavior they were working on avoiding). While this can be okay in some cases, it can also walk a line of  making individuals feel shameful and exposed. You need to take stock of how sharing your slip-ups makes you feel.
• Talk about it! If you’re not sure how all this sharing makes you feel, start talking! While writing and surfing (the net) are fabulous, it’s important to also be communicating with real, live human beings too. Make sure you’re bouncing ideas and feelings off your friends, family, or therapist. And if blogging about your journey is bring you down, it may be time to step away from the mouse.

For more tips, or to learn how to be a healthy reader of recovery blogs, check out my guidelines.

Has blogging or writing helped you in your recovery?