Mindfulness and Self Inquiry Article Contributed By: Laurie Little, Psy.D., Licensed Psychologist of Lindner Center of HOPE
Many individuals with eating disorders struggle with perfectionism and have high needs to control their thoughts, feelings, behaviors and environment. Underlying feelings of shame and powerlessness often lead to a coping strategy that tries to regain a sense of safety, security and control. Individuals with eating disorders may also struggle with impulsivity. This is where mindfulness and self-inquiry can be helpful.
They may engage in self-destructive behaviors without thinking beforehand of the consequences, both physical and mental. When thoughts demand that all things need to be perfect in order to be safe or acceptable, and the person feels powerless to manage their thoughts, feelings and behaviors, it creates a breeding ground for eating disordered behaviors.
Dialectical Behavior Therapy (DBT) and Radically Open Dialectical Behavior Therapy (RO-DBT) are two treatments that have been successfully implemented with eating disordered patients. While traditional DBT can use mindfulness to target the ED behaviors of impulsivity and emotional dysregulation (symptoms of under-control), RO-DBT focuses more on rigidity, inflexibility and excessive needs for control (symptoms of over-control).
Traditional DBT, for example, might be most effective for patients who struggle primarily with binge eating or purging, while RO-DBT may be more helpful for patients with Anorexia Nervosa, Orthorexia and compulsive exercise. Given that many individuals with eating disorders often have a complex set of thoughts, feelings and behaviors, it would make sense that learning skills from both treatments could be beneficial.
While traditional DBT focuses on teaching mindfulness skills to reduce impulsivity and self-destructive behaviors, RO-DBT teaches a process called Self-Inquiry to help improve cognitive and behavioral flexibility. Both mindfulness skills and self-inquiry can help reduce the severity of eating disordered thoughts and behaviors.
Mindfulness for Undercontrol
Mindfulness is the state of being aware. When we are mindful, we notice and observe thoughts, feelings, sensations and the environment. Mindfulness is learning how to pause before acting and to reflect on what is happening at the moment that is creating urges or emotional distress. Mindfulness allows us to notice without judgment and to be more purposeful in our words and actions.
When we experience shame and self-hate, we might have the urge to binge or purge in order to try to get rid of those feelings. Mindfulness allows us to pause and reflect on whether or not binging or purging will actually be helpful in this situation or if it will only continue the cycle of shame and self-hate. As we become increasingly more able to pause and reflect and consider other skills to manage our pain, the binge-purge-shame cycle reduces.
Self-Inquiry for Overcontrol
Self-inquiry is the manner in which we can observe our own thoughts, feelings, beliefs, perceptions and assumptions. It is a stance of openness and willingness to sit with and learn from the thoughts and feelings that we may otherwise wish to avoid. The goal of self-inquiry is not to come to a Truth, as we assume that one can never fully know the Truth about any situation. Unlike mindfulness, self-inquiry focuses on the process of understanding our own inner world, without having to defend, self-regulate, or make ourselves feel better.
When we hold the belief that our eating behavior or exercise absolutely must be done in a certain way, we will feel anxious and overwhelmed when we fail to live up to those standards. These beliefs will lead us down the path of further guilt and shame. It also reinforces additional efforts to regain control over our eating and exercise.
Learning the skill of self-inquiry allows us to pause and consider the origins of these beliefs and if those beliefs continue to serve us well. Self-inquiry can help us to sit with the discomfort, tolerate the feelings and all the accompanying beliefs, images and sensations.
When we can tolerate the discomfort and learn from it, we may be more inclined to let those beliefs go. We may be more willing to make healthier choices that leave us feeling more confident and balanced.
Eating disorders are complex illnesses with many variations in behaviors, thoughts and emotions. Two people with the same condition may present as remarkably different.
Complex conditions often require a variety of techniques and interventions. There are a multitude of skills within both traditional DBT and RO-DBT that can help patients with eating disorders. Clinicians who specialize in treating eating disordered patients may benefit from learning the philosophy and practice behind both traditional DBT and RO-DBT to provide the optimal care for their patients.
Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.
Lynch, T. R. (2018). Radically Open Dialectical Behavior Therapy: Theory and Practice for Treating Disorders of Overcontrol. Reno, NV: Context Press, an imprint of New Harbinger Publications, Inc.
About the Author:
Laurie Little, Psy.D., Licensed Psychologist
Dr. Little serves as the Director of Therapeutic Services, Residential at the Lindner Center of HOPE in Mason, OH. Dr. Little earned her Doctorate of Psychology degree from the University of Hartford in Hartford, Connecticut. She completed a two-year internship in Westfield, Massachusetts, that specializes in the training and implementation of Dialectical Behavior Therapy for adults with mental illness. Her dissertation studied how training clinicians in DBT helps to reduce therapist burnout.
Prior to joining the Lindner Center of HOPE, Dr. Little has maintained a private practice in Northern Kentucky since 2002. She has also worked in community mental health, college counseling, and hospital settings. Dr. Little has particular expertise in conducting psychological assessments, leading groups and providing consultation to multidisciplinary treatment teams.
Lindner Center of HOPE offers a disciplined approach to eating disorder treatment that combines psychiatric management, psychotherapy, nutritional services, and family engagement throughout the entire process. Board-certified clinicians offer the wisdom, compassion, and proven treatment modalities to successfully treat complex illnesses such as eating disorders, returning patients, and their loved ones, to more fulfilling lives.
The Harold C. Schott Foundation Eating Disorders Program at Lindner Center of HOPE includes services for adults and adolescents, females and males, while also incorporating research.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published April 5, 2021, on EatingDisorderHope.com
Reviewed & Approved on April 5, 2021, by Jacquelyn Ekern MS, LPC