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Ashley Solomon, Psy.D is a psychologist who specializes in the treatment of eating disorders, body image, trauma, and serious mental illness.

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Tag: change

23 Jul

Do diets work?

Ideas to Consider 6 Comments by Ashley @ Nourishing the Soul

It’s sounds like a simple question, and you might think you know my answer. I’ve talked about ditching dieting for years here, and I’ve expressed my distinct disdain for our culture’s obsession with weight loss.

But, honestly, it’s more complicated than a simple yes or no.

To answer the question, we have to first define what it’s asking, exactly. To start, we have to understand what we’re considering a “diet.” There are about a million and two commercial weight loss programs out there. There’s Atkins and Paleo and eating worms. Those we can easily put into the “diet” camp. They’re diets with a capitol “D.”

But what about your seven day juice cleanse or your doctor’s advice to cut back on carbs and salt? Are they diets? What about attending Overeaters Anonymous meetings and following the 12-step tenants. Does that mean you’re on a diet? And what if you’re in treatment for an eating disorder and are told to eliminate binge foods from your life? Did your therapist put you on a diet?

It gets complicated, as you can likely see. For our purposes, we’ll consider a diet any change to your dietary habits that involves reduction or restriction of intake for the purposes of weight control. So, eating a certain number of calories per day or cutting out a food group count as diets. Not eating meat on Fridays during Lent or drinking more milk to strengthen your bones does not.

Now the next question to be answered is what is meant by “work”? Essentially, how are we defining success.

This is where things get ugly.

Diet plans taut widely varying definitions of success. Some proclaim that your efforts will result in you being energized and strong, while others suggest you’ll be slim and suddenly sipping cocktails with A-list celebs. For most of us, we consider a reduction in weight to be the definition of a diet “working.”

But how much?

Most medically supervised weight loss programs don’t advocate for much more than a reduction of 10% of initial body weight. For some, that seems like small potatoes. But in actuality, it’s not. It takes a lot of effort on the dieter’s part and, according to many in the medical field, results in significant improvements in health.

So, say we take 10% of initial body weight as our definition substantial loss. How long does it need to be off before we can establish whether one was successful?

The answer, again, is complicated. For some, the second the scale hits the “magic number” is the moment when a diet is considered successful. Others use the definition of a year. Still others, myself included, believe that the reduced weight would need to be stable for two to five years for weight loss to be considered “maintained.” This is in part because we know that this is the period of time in which weight cycling often occurs. And we know that weight cycling is quite harmful to the body, and can be more dangerous that being a higher body weight.

So, with these definitions, when we go back to our original question — Do diets work? — we would think we could examine the research and have a final conclusion.

But we don’t! The majority of the research I’m familiar with suggests that long-term follow-up of individuals who have lost weight shows that weight is regained (and then some, for some). However, obesity researchers point to other studies that suggest weight loss can be maintained with proper follow-up.

So where do we go from here?

Maybe whether diets work is not the right question as all. Maybe we need to be asking, if they do “work,” are the risks associated with them (e.g. triggering eating disorder symptoms in some who are vulnerable, leading to weight cycling, etc.) worth the benefit?

That question might be a more personal one, and individual circumstances are always going to be an important part of the answer.

What do you think — Do diets work?

27 Nov

Can we really change for someone else?

Ideas to Consider 3 Comments by Ashley @ Nourishing the Soul

I’ve had it with my patients. I’ve had it with my parents. I’ve definitely had it with my friends. It’s the exchange that goes like this:

Them: I’m so frustrated that I couldn’t [insert: overcome my eating disorder, become a better listener, lower my blood pressure, learn Chinese, be more romantic, stop biting my nails]!

Me: And why do you think that was the case?

Them: I know exactly. It’s because I was never truly doing it for me. I was always doing it for [insert: romantic partner, family member, boss, the trial judge].

Me: Oh. (said in a profoundly empathic way, with a few nods of the head).

My head nodding has was always genuine because I got it. You can’t make changes, real changes, without really wanting it. For yourself. Right?

I have to admit I’ve bought into this idea over the course of my life. And maybe it’s well-founded at times. Internal motivation is nothing to sneeze at.

But sometimes I think we use the idea that change has to be for us as, well, an excuse. We believe that if we haven’t truly summoned the will to change, it can’t work, and so there’s really no point in bothering with the whole shenanigan anyway.

Take eating disorder recovery, for instance, since it’s something in which I’m daily immersed. There’s a familiar refrain among not just patients, but other professionals too, that says: It’s not working because I’m (they’re) not doing it for myself (themselves). I’m (he/she’s) doing it because everyone else wants me (him/her) to.

Because I work mostly with adults rather than children currently, I agree that self-directed motivation is important for long-term recovery. [In the case of children, things get a little bit more tricky…] Individuals do have to want long-term recovery for themselves in order to sustain the immensely hard work that the process entails. Fighting against every urge in one’s being to engage in an eating disorder is much harder over time if the person doesn’t believe in him- or herself or his or her ability to do it.

But (and you knew that was coming), I do not think that means that recovery cannot at least start out for someone else. Here’s the thing – many individuals with eating disorders struggle with major issues around worthiness. They often believe that there is something inherently wrong, defective, or less than about them, and so the idea of taking care of themselves is foreign and, at times, abhorrent. So to imagine engaging in treatment – something that many even feel is indulgent due to these issues – feels awful.

If there is a relationship in their lives, however, that is important enough to them to even nudge them into recovery, I see that as a major point in their column. Individual: 1, Eating Disorder: 0.

When it comes down to it, all change has to start with a value, something we want for ourselves. We don’t just stop biting our nails because we stop enjoying it or it stops serving it’s purpose of relieving stress or boredom. We stop (when and if we do) because something else is more important. It could be the photographs that will be taken at our pending nuptials, our reputation among our co-workers who give us weird looks for our gritty little nails, or the fact that we realize that dealing with stress in this way is not particularly effective. Or, it could be because it irritates our partner to hell and we care enough about that person that we don’t want them to be irritated all the time.

The final reason is not a bad one, despite the bad rap that it often gets. We use the fact that we won’t or can’t change for someone else as a badge of honor or self-esteem. Hell, no, I won’t cut my hair for him!

But what if he actually has a worthy opinion, being outside my own head and all?

The fact is that relationships take compromise, and sometimes they are just the impetus we need to make healthier and better choices in our lives. Relationships can push us to do things we never thought we would – or wanted to – do, and sometimes with really great results. Wow, maybe I do look better with short hair… 

Of course, we have to manage our expectations — we can’t make another person love us or love us more with our choices. We can’t change into something that they approve of if the issues are deeper and less resolved. But sometimes, just sometimes, we can change for someone else. If we love them – and, ultimately, ourselves – enough to do so.

20 Sep

Five Steps to Overcoming Your Fear of Failure

Ideas to Consider 7 Comments by Ashley @ Nourishing the Soul

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{image credit :: PixelPlacebo}

Jeremy was absolutely brilliant. Not only that, but he was intuitive, capable, and extraordinarily hard-working. Jeremy was the kind of guy you go to high school with who you expect to hear about ten years later at the helm of a Fortune-100 powerhouse or systematizing a way to provide vaccines to every child in Africa.

But Jeremy hasn’t achieved that kind of notoriety, nor has he been successful professionally or financially. In fact, he’s kind of your average dude these days – working at a job he at best finds mildly stimulating and washing down the deep gnawing inside him for something more with a can of beer each night.

It’s not so much that Jeremy’s job is unspectacular or that he enjoys his nightcap, but the travesty here is that what holds him back from living a life he values is fear. Jeremy suffers from an affliction with which many of us can relate, but that we rarely discuss – a fear of failure. It’s Jeremy’s fear of failure that has held him captive in a world that continues to disappoint him.

If you’re anything like Jeremy, you’ve been served the platitudes time and time again. “Nothing ventured, nothing gained!” they tell you, urging you to take what feels like a flying leap out of your comfort zone. What do I gain, you wonder. Terror? Pain? Inevitable shame?

The good news is that like any other fear, a fear of failure is malleable and doesn’t have to continue to stand in your way. Consider these strategies to tackle the beast.

 

1. Recognize that not only is failure okay, it’s necessary.

Somehow we’ve created a society in which failure seems like the ultimate loss, when in fact it is the birthplace of innovation. Take Thomas Edison, who according to legend made over a thousand attempts in creating the carbon filament for our light bulbs. When asked about how he felt to have failed so many times, Edison reportedly retorted, “I have not failed. I’ve just found 10,000 ways that won’t work.” What Edision understood was the necessity of the experience of failure. While rare, there are people and organizations who recognize this fact. Regina Dugan, head of the defense organization responsible for the internet’s precursor and GPS, supports failure in her staff. She said,

It’s understood that for us to have those really big wins, we’re going to have failures as part of that. Failure isn’t the problem. It’s the fear of failure that’s the limiting factor there. We have to push through. We say at Darpa, you can’t lose your nerve for the big failure, because the nerve you need for the big success is the exact same nerve—until the moment you know which one it’s going to be. Not before.

 

2. Remember it’s won’t be as bad as you think it will be. [It’s never actually “EPIC.”]

I’ll go out on a limb here and make the statement the anticipation of failure causes significantly more pain than failure itself. It’s what we sometimes calls anticipatory anxiety – the fear of of a future outcome that causes us distress. Those with panic disorder are all too familiar with this idea, and it’s why the first line treatment for panic disorder involves exposing individuals to their fear (having a panic attack) and helping them become aware of the fact that, hey, I’m alive! Similarly, the experience of failure most often doesn’t end up nearly as catastrophically as we envision. It can help to recall a time that you did fail. It might have hurt or produced embarrassment, but for most of us the experience didn’t lead to our ultimate demise. Unless you fail at at swimming with man-eating sharks. Now, that’s a failure.

 

3. Fail intentionally. Seriously.

Yes, you read that right. I want you to go out and screw up. Screw up big time, in fact. Just like with battling panic, exposure to the feared stimulus is ultimately the way to resolve intense anxiety about something. So if you’re something is failing, it’s going to be important to have the experience of failure and recognizing coming out on the other side. That might be mean setting up opportunities to fail. For me, that could involve tackling a physical activity that requires a lot of coordination. I know, and have accepted, that I am not a particularly coordinated person, and that I will likely fall flat when I make attempts at things like rollerblading or yoga balance poses. Knowing this and doing it anyway helps me see it’s okay to struggle, it’s okay to not be perfect, and it’s even okay to get pissed off about it.

 

4. Develop your sense of competence.

Adam McCaffrey at Carleton University did some interested research on procrastination – the sneaky relative of fear of failure – and found that the relationship between the two is more complicated than we once thought. It would make sense that fearing failure would lead to us to putting off tasks, but what McCaffrey found was that when we control for our perceived competence, fear of failure no longer predicted procrastination? In English? This means that even if we fear failure, perceiving ourselves as capable of tackling the task at hand leads us to not putting it off. So we can fear it and still do it. Easy breezy, right? Certainly not, but this gives us another place to look to address the way in which our fears are impacting our lives. We can work on building our sense of competence by practicing things we find difficult. And then practicing them again.

 

5. Recognize if you’re undermining your own efforts so you can stop trying. And then stop!

Our minds are sneaky like this sometimes, and I see this happening with my writing. I’ll be so excited to write a post and it’ll be brewing inside my mind for days as I sort through ideas and word choices. And then the time will come to sit down and write and… and I’ll watch TEDx videos. Or surf facebook. Or plan an imaginary trip to Argentina. I’ll do anything but write. If you know me, you know I’m not a procrastinator, but I am someone who gets caught up in fears of failure. So I’ve learned to recognize my attention deficit as my brain’s way of protecting me from struggling through writing and risking failure. With this knowledge, I can go into my work with a greater sense of awareness and refocus myself when the urge to hit YouTube shows up. I can acknowledge my fear and draw upon my sense of competence to realign myself with my purpose – not to avoid failure, but to create something great.

 

A final thought, and one that I think is simply but eloquently stated by William D. Brown: “Failure is an event, never a person.” We can fail, but we are never truly be a failure. I don’t know about you, but that’s incredibly liberating to me. So take a risk, make a move, and allow yourself to fail miserably. Unless it’s swimming with sharks….

What’s something you’ve been afraid to try for fear of failure?

NTSMedium1

13 Jun

Is insight really important in changing our behavior?

Ideas to Consider 10 Comments by Ashley @ Nourishing the Soul

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{Image Credit :: nicholaswray.com}

A few months ago, one of my patients brought in a clipping of an article she had run across in the New York Times. The piece, entitled, “When Self-Knowledge is Only the Beginning,” described how the insight developed in the therapeutic process is not sufficient to bring about happiness in a person’s life, also suggesting that having it can actually be harmful in some cases.

Like any good insight-oriented therapist, I naturally wondered about the meaning of my patient carefully snipping this article from the newspaper, packing it away in her bag, and bringing it to my office. I was curious about what that act might signify for her, and what she might be trying to communicate to me without words. We eventually did explore this together, and in the process discovered a great deal about patient’s feelings about therapy in general and ours in particular. It provided an opportunity to reflect on the hard work that she had done in treatment and what areas of her recovery we had yet to address more fully. It allowed for a closer examination of our relationship and the dynamics at play, dynamics that transcend our six-month relationship and speak much more to the relationships that she has with others in her life.

As I thought about the fruitfulness of that session, I realized that if I hadn’t been concerned with insight, all of the self-awareness, the understanding of where further work needed to be done, would have been lost. If I had said, “Gee, thanks for passing this along!” and dutifully stuck the article in her file and never brought it up again, what an opportunity I would have missed.

To be fair, the piece in question does not negate the value of insight entirely, and in fact makes several good points about its role. But some in the mental health field, and certainly in the community at large, charge those of us who value insight with “wasting time” and not really helping the individual change. Insight doesn’t create happiness, they say.

So what role does insight play in therapy? And how does it help someone in recovery?

Good questions. I’ll thank myself for asking…

When I talk about insight, I’m referring to self-awareness – awareness of the meaning that underlies the behaviors that we engage in, the relationships that we partake in, the thoughts and feelings and reactions that we have.  To me, this is at the heart of living mindfully.

Once we have developed a deeper understanding of why we make the choices that we do, we are free to make different choices. We are free to explore alternate realities for ourselves because we have done the work to decipher what our previous realities meant for us.

We can understand that when we were nine years old and eating to the point of discomfort, we were protecting ourselves from much harsher and threatening burdens. With that understanding, we can begin to shift our stance toward ourselves from one of shame and disgust to one of a compassionate and caring older self, one that can gently soothe the nine-year-old and let her know, “Things are different now. You don’t have to be so afraid.” And we can begin to let go of the need to hold on to the at-one-time vital behaviors that have kept us locked in a pattern of self-destruction.

One of my favorite quotes, one that I amazingly picked up from twitter, is this: “We cannot make choices from the same mind that believes we have no choice.”

Insight breeds choice. It births emotional freedom – freedom from the chains that binds us and from the minds that tell us “This is who you are! You can do no different. You can do no better.” Insight tells us that we can do better and helps us understand the ways out of the labyrinth that our early experiences can sometimes create.

We can, of course, become too tied to insight, just as we can become too tied to anything. We cannot stop at the level of insight, but have to be willing to utilize the understanding and self-compassion that we create to initiate positive changes in our behavior. At times we need gentle guidance to do so, or even a slightly harder push. Therapists should be trained and skilled enough to know when that push is needed and how to do so in a way that builds trust rather than diminishes it.

So can insight lead to a happier life? I suppose there’s no clear answer to that. What I do know is that insight can lead to a more authentic life, one lived from a place of mindful awareness, one lived with a sense of self-understanding and empowerment to make to healthy choices. I don’t know about you, but that’s the kind of life I want to live.

Do you think developing insight is important in therapy? What has your experience been with insight?

NTS-Medium

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