Somatic Wisdom and the Polyvagal Theory in Eating Disorders by Inge Sengelmann, LCSW, SEP, RYT 64 Sensory Feeding and Eating Disorders by Rodolfo Garcia Otero, MA

Somatic Volume 4 Number 2 Psychotherapy Today

Fall 2014

Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 2

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Somatic Psychotherapy Today

Our Feature Stories

14 Are You a Nutrivore? An Interview with Jayson Calton, PhD, and Mira Calton, CN By Nancy Eichhorn, PhD 24 Turning-The-Tables. An Interview with Helayne Waldman, ED.D, MS, CNE By Nancy Eichhorn, PhD 30 Food For Thought: You Feel What You Eat: An Interview with Merrily Kuhn, RN, PhD, ND, PhD By Nancy Eichhorn, PhD 36 A Voyage into The Gut By Stephanie Pollock, MA, CHC, EPC, CYT 40 Nine Steps to Calm the Anxious Mind Using Food and Nutrients By Trudy Scott 46 Exploring Binge Eating Disorder Through the Body By Debbie Cotton, MA, BHSc, ND 60 Somatic Wisdom and The Polyvagal Theory in Eating Disorders By Inge Sengelmann, LCSW, SEP, RYT 64 Sensory Feeding and Eating Disorders By Rodolfo Garcia Otero, MA

68 Are Eating Disorders Truly a Thinking Disorder ? An Interview with Judith Ruskay Rabinor, PhD By Nancy Eichhorn, PhD 74 Dare To Be You! By Isabelle Tierney, MA, LMFT 78 Freedom: An Interview with Diane Israel, PhD By Nancy Eichhorn, PhD 86 Body Awareness as Key To Detecting Predators and Advancing Eating Disorder Recovery By Joanna Poppink, MFT

Volunteer Magazine Staff Nancy Eichhorn, PhD Founding Editor, Layout Design Diana Houghton Whiting, M.A., BED Cover Design, Layout

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Our Usual Fare

10 Across the Pond 92 International Connections By Jill van der Aa, PhD and Lidy Evertsen, PhD By Asaf Rolef Ben-Shahar, PhD 12 Join the Conversation 96 Current Research in Review By Nancy Eichhorn, PhD By Dawn Bhat, M.A., M.S., NCC 56 Body Wise 100 Resources by Jacqueline A. Carleton, PhD By Kamalamani & the USABP Interns

Reviews and Reflections

55 Reclaiming Yourself From Binge Eating 22 Naked Calories and Rich Food, Poor Food Reviewed by Nancy Eichhorn, PhD Disorder Reviewed by Sasha Dmochowski, MA 28 The Whole Food Guide for Breast Cancer Survivors 71 A Starving Madness Reviewed by Phillipe Kleefield Reviewed by Samah Ahmed Ikram 44 The Anti-Anxiety Food Guide Reviewed by Phillipe Kleefield 81 Beauty Mark Reviewed by Nancy Eichhorn, PhD 52 Reclaiming Yourself From Binge Eating Disorder 89 Healing Your Hungry Heart Reflections with Leora Fulvio, MFT Reviewed by Nancy Eichhorn, PhD

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From Our Founding Editor

This issue focuses on a topic near and dear to me: eating psychology—a movement that shines a spotlight on the dynamic psychological relationship we have with food and its impact on our health and emotional wellbeing. Advances in holistic and functional nutritional health are changing the way we understand the role our diet plays in obtaining and/or maintaining optimal health. During our interview with Dr. Helayne Waldman ED.D., she noted that it is time to expand the term eating disorder:

“If you are sabotaging your health, if you disregard your own well-being in any kind of clinical field, this is considered disordered thinking/behaving. When you eat sugar, drink that coke, or engage in a variety of other eating habits that undermine your health, I believe that too is an eating disorder. I think the ‘eating disorder’ needs to be broadened to honor our own well-being through healthy habits with food, it’s an eating disorder. I think the term should be broadened to honor our own well-being through healthy habits with food.”

Everyone has a relationship with food, and as Stephanie Pollock writes in her article, A Voyage into the Gut, “There is no such thing as emotional eating because we are emotional beings, and we eat, thus all eating will always be an emotional experience.”

Our contributors share their personal and professional stories to highlight the connection between eating psychology and digestion, mood and depression, immunity and food allergies, cancer, fatigue, osteoporosis, overeating, binge eating, not eating, and purging. They discuss how our thoughts, feelings, and beliefs influence our nutritional metabolism and health, our emotional metabolism and health, and our spiritual metabolism and health. And, they share healing modalities that may offer relief and resolution. All are practicing practitioners (therapists, coaches, educators) with successful experiences supporting clients who are willing to approach their own dynamic relationship with food and face the negative consequences and experiences in order to ‘turn-the-tables’ and engage in healthier ways of eating and being.

Join us as we explore the connection between the brain and the gut brain and the impact of their alliance on our digestion and behavior.

We welcome your response.

Warmly, Nancy Eichhorn, PhD [email protected]

From Our Cover Designer

I grew up in a city that claimed to have the most restaurants per capita in the entire US. The variety of atmospheres and foods was mindboggling. Going out to eat had many layers of meaning for status and socially. As with many people food holds a lot of emotional and social meaning. How, when, and why it is eaten. It is interesting to see the connection between food and all the different meaning we place around it and how it can be helpful and nourishing or harmful and challenging.

Sincerely, Diana Houghton Whiting, M.A., BED

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From the USABP President

Dear Somatic Psychotherapy Readers,

I love to eat, but I have a hard time feeding myself. I feel full, yet sometimes I am unsatisfied. I am voracious, while also quenched and picky. What am I talking about here? It’s all about the psychology that pulls the topic of eating and food into a depth and meaning way beyond the ground of survival and food. There’s probably no human activity that calls on so many brain regions as food does (maybe sex?). It’s a perfect topic to be addressed by our field, Somatic Psychology—the psychology of the body.

By looking closely at Eating Psychology, our unique perspective may shed light on what is really eating us up these days.

Bon Appetit!

Beth L. Haessig, Psy.D. President, United States Association for Body Psychotherapy

APA ACTION COMMITTEE

The USABP is forming a committee whose purpose will be to create a Somatic Psychology division of APA. The goals are: to determine the necessary steps involved in creating a division of APA and to take those steps in order to make a strong application to APA. If you are interested in being part of this important work, please be a member of this committee!

Contact the President of USABP, Beth Haessig, Psy.D. at [email protected]

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From the Managing Editor

International Body Psychotherapy Journal: The Art and Science of Somatic Praxis

of Robyn Burns, kept the USABP From reaching a small group of three Journal going for ten years. These hundred therapists, we are together last two years have been a mammoth reaching thousands of people, all effort to transition from an in-house over the world, who are not only Association Journal to a peer interested in passively reading about reviewed open access Journal, from a what we are doing but actively two person to a many person effort. participating with us. I’ll come back to that. Jill van der Aa It’s clear! One of my obsessions is But why the obsession? about relating, about being heard, Dear Editor of Somatic about community – working together Psychotherapy Today, Because we, (as you do), feel we in a team. While the load of creating have something valuable to offer, and the IBPJ does fall squarely on a small I write this on your birthday although we would like to make it available to number of people: Editor, Managing it will be read when you are six people from complimentary health Editor, Assistant Editor, Peer Review months older! I was glad to hear that disciplines, to clients, and to anyone coordinator, and German Editor, we today you would celebrate with involved with working with people! have been building a wider team. chocolate cake and champagne! Healing comes through working with Abstract translators come from about So this is a good time to say what a the whole person and that also means ten different European countries and great job you do, pretty much single- working with a combination of body- some are now beginning to translate handedly I understand, with the help based, non-verbal methods as well as articles back into their own language, of your wonderful designer Diana traditional verbal ways of bringing in Greek for instance. Each article is Houghton-Whiting. SPT is lively, things together. For too long the head peer reviewed by three reviewers colourful, modern, committed, has ruled – we want the body to be providing mentoring for authors as encouraging, inspiring, and makes a heard and felt. Doctors and well as an opportunity for senior wonderful contribution to this new psychiatrists, for instance, could do members of the field to impart what and exciting field we are working in with a good dose of somatic they have learned. and for. By the way, I wonder psychology, and it might work a sometimes how you fit it all in and good deal better than some of those This is an enormous job. Most keep the rest of your life going? sugar-coated pills! scientific Journals use an automated system but our process is done We, on the editorial team of the IBPJ, Thankfully, through all of our efforts, manually. To get such a system struggle to keep our lives going so a great range of contributions is would cost at least $6,000 and that is we do understand. It is what happens coming into the Journal now, from a money neither of our two when you become committed to diversity of methods, from clinical Associations, USABP and EABP, something bigger than yourself – descriptions to research reports and have. We are of course looking for a you become obsessed. You live it day in-depth book reviews, from senior maesenas, or an external publisher, and night. By the time this is being trainers and writers to students but are wary of letting go of control read, both the Editor and the writing their dissertations, from US at this exciting stage. Managing Editor will have reached a and European sources. Keep it ripe old age! So I (the Managing coming! We love it. It is OK for the Editor and Managing Editor) sometimes ask myself, isn’t it Editor to reveal their obsessions at time to get some addiction therapy, And we love the sense of community this ripe old age, but Jacqueline slow down, find some younger building. While the Journal goes for Carleton, PhD, mentors young people to take over and retire? in-depth analysis, the SPT and the graduate students who have been LinkedIn discussion groups set up by doing a lot of the work, and I It is. But will we? Serge Prengel are complimentary wondered what they were getting out with interviews and discussions from of their voluntary commitment to the Jacqueline Carleton, with the support which further work is developing. IBPJ?

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Diane Cai has been with us for two years now developing from peer review coordinator to Associate Editor. This position will add to her professional advancement very directly in the future. Josh joined us recently, and I asked him to describe what he does and what he gets out of it.

In conjunction with Diane Cai, I handle the submissions process from initial receipt of articles, through peer reviewing, to revisions and receipt of final drafts. In some way I am the “middleman” between our peer reviewers and the authors who publish in our journal. This has been a great responsibility to have, providing great experience and insight to the inner workings of academic journals. My experience working with the International Body Psychotherapy Journal will be very useful as I continue my training within the doctoral program at the University of Western Ontario in the fall. My ability writing articles is greatly enhanced by knowing what peer reviewers are looking for in publishable material and as I engage in peer reviewing in the future, I will have already been widely exposed to the peer review process. Joshua David Wright

The International Body Psychotherapy Journal is a big undertaking and we have been very lucky with the enormous number of people who have contributed to its development so far. something for you contact us. In the meantime we continue with our obsession. As birthdays pass, time marches on and we are constantly on the lookout for younger people to participate and pass Jill van der Aa, Managing Editor the baton onto so if you read this letter and think this is [email protected]

CALL FOR PAPERS

The International Body Psychotherapy Journal is Seeking Articles for its Special Issue Spring, 2015: Research Guest Editor: Jennifer Frank Tantia, PhD

The International Body Psychotherapy Journal is a challenged through qualitative and quantitative research in peer-reviewed, biannual journal that supports, promotes order to solidify its value within the field of and stimulates the exchange of ideas and research psychotherapy. regarding body psychotherapy and all disciplines related to it. We are seeking research articles from both professionals and students from the somatic Research in Body Psychotherapy is integral to the psychotherapy field and adjacent fields for this special field’s growth, development, and communication among edition, to amplify the visibility of current studies in the related fields of psychology. As an emerging paradigm, field. Continued on page 91 theories from Body Psychotherapy must be explored and

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Across the Pond

European Association for Body Psychotherapy

Jill van der Aa General Secretary/Vice President Lidy Evertsen EABP President

Jennifer Tantia, PhD, once put a discussion on LinkedIn about ‘the elevator pitch’. This is what you say to someone in a lift when they ask you what you do and you want to explain it all before you get out on Floor 3. I say, “body psychotherapy,” and when I get a blank look I stumble through a couple of well-worn sentences and then the door opens and my lift companion gets out. “Oh you mean massage,” they might say as the door closes, so I am always searching to find ways to explain body psychotherapy in ever more simple words.

This is one of the difficulties we and USABP definition (http:// brings himself and his clients onto face at the moment, and we are all www.eabp.org/about.php), there is a the page and gives simple examples trying to describe exactly what it is principle that is different between of exercises. You can order it we do and how it is different from those methods and body through Karnac Books. body therapies or psychoanalysis. psychotherapy: the techniques used Thankfully many people are a little may differ too, but more-so, the more erudite than me when writing therapeutic positioning and the about it. understanding of the therapeutic relationship differentiate the two Asaf Rolof Ben-Shahar is one of ways of working with people. the new generation of therapists who Many types of bodywork, like is willing to take risks, to play, and massage, physiotherapy, and to experiment as is so clear in his others, aim at improving the writing. You pick this book up and client’s bodily state. While the don’t want to put it down! In psychological benefits of these Touching the Relational Edge, Asaf methods cannot be denied, they is quite explicit about the difference are neither necessarily a central between all the different modalities: axis of the work, nor are they part of the contracted “Many types of bodywork and relationship as they are in the somatic therapies maintain a holistic clinical practice of the body approach, aiming at integrating body psychotherapist . . .” (p. xxvi). -mind processes with their clients. However, as argued by the EABP He has much more to say and

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Several other authors have books two continents. While serving on on body psychotherapy coming out the EABP Board as General this year. I write this in April and you Secretary and then President, are reading it in September. Look for Courtenay was the instigator Ulf Geuter’s book if you speak behind much of the structure of German or you might see his keynote the EABP such as the EABP speech if you are at the EABP Lisbon website, the Training Standards, Congress. He is specifically, “dealing and Membership Criteria, the with the significance of working with Bibliography and the Science emotions and emotional processes in Committee. He is the publisher body psychotherapy.” and editor of Body Psychotherapy Publications In 2006, a book a came out in endorsed by EABP and German, a Handbook of Body recognized by USABP, under Psychotherapy, (Schattauer 2006). which he has edited three Lucky for all the German collections of articles, The psychotherapists! But being a foreign Historical Basis of Body -language-illiterate New Zealander I, Psychotherapy, About the Courtenay Young Jill, have been waiting on tenterhooks Science of Body Psychotherapy, while this book has been undergoing and About Relational Body translation into English/American Psychotherapy. He is the editor of the am a body psychotherapist (or which is close to New Zealandish! International Journal of somatic psychologist). We don’t Eight years later and the book is Psychotherapy ,and in the last two need to add the ‘pitch’. In this vision, undergoing a metamorphosis into The issues of the International Body the person responds with, ‘Ah, that’s Handbook of Body Psychotherapy Psychotherapy Journal (these are two interesting, I know what it is’. Then and Somatic Psychology. And it is not different Journals), we have he or she tells us about people [s]he just a translation of the original! It is published a two-part article by knows who have experienced the a brand-new, up-to-date edition with Courtenay (and Gill Westland) effects of this kind of therapy before many new chapters and new authors. entitled, Shadows of Body we get out at level 3. It is of a similar size, currently about Psychotherapy. You can find it along 500,000 words, 94 chapters, and with other wonderful articles and full In order to get there we, body possibly 1,000 pages. The original issues of both the IBPJ and the psychotherapists, have to write more editors, Gustl Marlock and Halko USABP Journal, dating back to 2001 and more. We have to do research, Weiss, have been joined by in the IBPJ archive. write about our theories, and also Courtenay Young and Michael Soth, about our clinical practice. Hopefully and the great thing about this Sometimes I look back and think, in a way that mirrors our Handbook is that it contains articles Courtenay created all of this single- profession— writing from our bodies from practitioners and researchers handedly. Does he ever sleep? Well, and minds together. from many different sub-modalities he does sleep, and there are many of body psychotherapy/somatic others in both the US and Europe It occurs to me that a greater part psychology. who have contributed to creating our of professional literature in general Associations and keeping them going. seems to be written from minds in the I can hardly wait until February New psychotherapists are coming first place. That leaves me, as a when it will finally appear published into our Associations and joining in reader, somewhat tired and split. And by North Atlantic Books, Berkeley, this wonderful creative endeavor of every time I read a book or article CA, who have produced a number of bringing our work to a wider public. that allows me to directly enter into books on body ______my complete being, into my body and psychotherapy. Jill has brought some really into my mind at the same time, I exciting publications to our attention. experience an understanding that Those of you who follow the They are worthwhile the attention of makes me happy and enthusiastic. wonderful LinkedIn discussions the wider world also. know Courtenay Young!! For So, I like to invite us all, when anyone who doesn’t, Courtenay was Our vision is directed to that trying to find the elevator pitch for the originator of this column and was moment when we step into the body psychotherapy, to let our bodies the person who created a bridge elevator and the person next to us start to answer and let our minds find between our two Associations and the asks us what we do, and we say, “I the right words.

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Join the Conversation

Communication is an essential part of all relationships, and the Internet affords opportunities to network with like-minded colleagues and participate in forums that challenge your thinking and ways of doing. Join the conversation and voice your thoughts on Facebook, Google, LinkedIn, ResearchGate, and more.

Eating Disorders and the Internet

The Hazards of Pro-Ana, Pro-Mia, and Pro-Ed websites

Online support groups have proliferated with blogs, social networking, chat rooms, websites, Instagram, Pinterest, and more offering men and women dealing with an eating disorder help and information, links to resources and a support community. While many of these sites are beneficial, other sites, disguised as elite and exclusive communities, actually promote eating disordered behaviors. Pro-Ana aka Pro-Anorexia, Pro-Mia aka Pro-Bulimia and Pro Ed aka Pro-Eating Disorders are terms used to describe these online communities. Visitors are motivated to join their elite and exclusive group with the lure of compassion, support, connection. Yet, these sites are dangerous and promote eating disordered behaviors. Borzekowski, Schenk, Wilson, and Peebles (2010) studied 180 sites (search terms included phrases such as Pro-Ana and thin and support). Of these sites, 83% contained suggestions to engage in eating disordered behaviors while a minority provided true support and real data on recovery.

These sites create unhealthy communities that glamorize and idolize images of emaciated and extremely thin people. They imply that food and weight are the enemy that must be avoided at all costs so the sites encourage and teach dangerous eating behaviors. Thinness is the ultimate goal and denial reigns when it comes to serious illnesses. Jett, LaPorte, and Wanchisn (2010), looked at the effects of exposure to these sites when healthy girls viewed them. They exposed healthy college women who had no history of an eating disorder to 1.5 hours of Pro-Eating Disorder sites. Data showed a decrease in caloric intake the week following the exposure; some study participants admitting they used techniques and tips they learned from the sites for up to three weeks after the exposure. Many noted having strong emotional reactions to the site content.

Pro-Recovery

The new movement is to promote Pro-Recovery Websites such as Something Fishy, which has addressed eating disorder recovery since 1995, and the National Eating Disorders organization. Both of these websites offer incredible information, resources, and connections for support: http://www.something-fishy.org/sfwed/prorecovery.php http://www.nationaleatingdisorders.org/recovery

References:

Borzekowski, D.L.G., Schenk, S., Wilson, J. L., & Peebles, R. (2010). e-Ana and e-Mia: A content analysis of pro-eating disorder web sites. American Journal of Public Health. 100: 1526-1534.

Jett, S., LaPorte, D. J., & Wanchisn, J. (2010). Impact of exposure to pro-eating disorder websites on eating behaviour in college women. European Eating Disorders Review.

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Movement-Based Embodied Contemplative Practices: Definitions and Paradigms

By Laura Schmalzl, Mardi Crane-Godreau, and Peter Payne

Published April 14, 2014

doi:10.3389/fnhum.2014.00205

Hot off the press, a new, open-access article published in Frontiers in Human Neuroscience mentions Somatic Experiencing (SE) and cites Peter Levine. While SE was not central to this particular paper, the hope is that the perspective will help to broaden the appreciation of its use.

You are free to copy and distribute this article. As noted, this is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited, and that the original publication in Frontiers in Human Neuroscience is cited, in accordance with accepted academic practice. No use, distribution, or reproduction is permitted which does not comply with these terms.

Links to the full text can be found at: http://journal.frontiersin.org/Journal/10.3389/fnhum.2014.00205/full http://www.readcube.com/articles/10.3389/fnhum.2014.00205

Abstract:

“Over the past decades, cognitive neuroscience has witnessed a shift from predominantly disembodied and computational views of the mind, to more embodied and situated vie of the mind. These postulate that mental functions cannot be fully understood reference to the physical body and the environment in which they are experienced. the field of contemplative science, the directing of attention to bodily sensations has so far mainly been studied in the context of seated meditation and mindfulness practices. However, the cultivation of interoceptive, proprioceptive and kinesthetic awareness is also said to lie at the core of many movement-based contemplative practices such as Yoga, Qigong, and Chi. In addition, it likely plays a key role in the efficacy of modern therapeutic techniques such as the Feldenkrais Method and the Alexander Technique. In the current paper we examine how these practices are grounded in the concepts embodiment, movement and contemplation, as we look at them primarily through lens of an enactive to cognition. Throughout, we point to a series of challenges that arise when Western scientists study practices that are based on a non-dualistic vie of mind and body.”

Would you like to discuss with colleagues around the world your thoughts, findings or questions? The Somatic Perspectives on Psychotherapy group on LinkedIn is your virtual community, already shared by over 2,500 kindred spirits: http://linkedin.somaticperspectives.com

This group includes subscribers to SomaticPerspectives.com, members of the US Association for Body Psychotherapy (USABP), members of the European Association for Body Psychotherapy (EABP), as well as people who are simply interested in joining our conversations.

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Are you a Nutrivore?

An Interview with Mira Calton, CN and Jayson Calton, PhD

By Nancy Eichhorn, PhD

Picture a vibrant, vivacious 30-year-old woman in the prime of her career—she owns and runs a successful public relations firm in Manhattan specializing in high-end fashion, and film and restaurant promotion. She’s flying high on life until she receives life altering news: in one earth-shattering, medical-moment her life is forewarned to change, drastically. Prepare for full time care, she’s told, your bones are brittle beyond repair—advanced osteoporosis the culprit, traditional Western medicine unable to offer more than the soon-to- be invalid prognosis.

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Now, some women may respond with a poor me mentality and succumb. Others may move fast and furious streaking forward grasping at life in complete denial of their diagnosis thus hastening their physical descent into fractures and splints. Our young heroine, Mira, however, moved in a methodical manner—a mission lay ahead. Keen on recovery, she researched options, treatments, and care-givers outside the traditional medical community. She traveled to Orlando, Florida for an appointment with Jayson Calton, PhD, a fellow of the American Association of Integrative Medicine, a Diplomat of the College of Clinical Nutrition, and a Board Certified Micronutrient Specialist (these among a long list of distinguished degrees, certifications, publications, and successful clinical work). He was noted for his nutritional work helping clients with obesity, diabetes, osteoporosis, cancer, celiac disease, depression, migraine headaches, high blood pressure, immune system disorders, and more. Mira met her match—medically as well as romantically. Together they mapped out the course of her skeletal decline and researched ways to both halt the progression and transform it to create a healing trajectory. Their experiences catapulted them into a lifetime career studying micronutrients—any vitamin or mineral that is essential in small amounts for the proper growth and metabolism of living organisms—and helping people achieve optimal health.

“When Mira was first diagnosed and made her way Micronutrients: Their role in maintaining health and into my office, we looked at how to get the deficient treating illness minerals and vitamins she need (calcium, magnesium, and vitamin K2) into her body,” Jayson says of their Casimir Funk, a polish biochemist, formulated the meeting back in early 2000. Jayson understood the nature concept of vitamins (originally called ‘vital amines’) of micronutrients and their role in health and illness. He in 1912. He was inspired by the work of Christiaan knew the delicate interplay between vitamins and Eijkman who was researching the disease known as minerals—increases in one results in deceased absorption beriberi. Eijkman had documented that people who ate of another—and that homeostatic balance resulted in brown rice were less susceptible to beriberi than people optimal health. Mira’s osteoporosis (her reduced bone who only ate fully milled rice. Curious, Funk wanted to mass that lead to increased skeletal fragility and isolate the substance responsible. His work resulted in the susceptibility to fractures) resulted from micronutrient discovery of vitamin B3—niacin. A forerunner in the field deficiencies. The key to a cure was in micronutrient of nutritional science, Funk researched and wrote sufficiency (Agiratos & Samman, 1994; Allen, de extensively about the etiology of deficiency diseases and Benoist, Dary, & Hurrell, 2006; Calton, 2010; Watts, their treatment (e. g., beriberi, scurvy, pellagra, and 1988, 1990). rickets). He discovered that many human diseases were caused by a lack of certain nutrients necessary for “Micronutrient deficiency is the most widespread and metabolism (that were readily available in some foods) dangerous health concern of the 21st century, effecting and thus developed his theory on the interrelationships nearly 100% of the people on this planet,” Jayson says. between vitamins and minerals. Micronutrient deficiency More than 2 billion people in the world suffer from is scientifically linked to the most of the modern health micronutrient deficiencies, which are largely caused by conditions and diseases including a higher risk of being dietary deficiencies of vitamins and minerals, even small overweight, obesity, cardiovascular disease, cancer, amounts can result in detrimental effects (Allen et al., diabetes, osteoporosis, and more (Allen, de Benoist, Dary, 2006). & Hurrell, 2006; Calton, 2010; Watts, 1988, 1990).

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Based on Funk’s work as well as on carbohydrate, low fat, Paleo, Primal, decades of research that followed, the low calorie, and gluten free. Calton’s predicated their research and Regardless of the diet people follow, Every work on what they call, ‘The the Calton’s stress that it is not about Micronutrient Sufficiency Hypothesis the diet but about the micronutrients of Health’: “If a condition or disease in the food and how the body absorbs can be directly linked to a them and uses them—micronutrient micronutrient deficiency, then it can deficiency is a real concern. disease is be prevented and/or reversed through sustained sufficiency of the deficient “A low calorie diet means less food micronutrient(s).” and fewer nutrients,” Jayson explains. “A vegan diet is 73% “It may seem simplistic,” Mira deficient in essential micronutrients directly says. “And it’s where we believe such as B12, which is found in animal nutrition is going. It used to be that products (and results in low energy), fat was bad, calories were bad, just and Omega 3 oils, which mostly get rid of them and you will be fixed. come from fish. If you are eating soy, But now we see other cutting edge spinach, grains, and legumes every linked to nutritionists focusing on day you are potentially consuming micronutrients as well, even Dr. Oz high levels of oxalic acid, which and Dr. Hyman are focusing their depletes calcium and magnesium. work here. When we wrote our first The Paleo diet is the most popular book, Naked Calories, the fact that right now. People think they are a nutrient we want to use the word eating this ancestral diet so they must micronutrient scared away almost be getting all they need, but the diet every publisher. We are trying to is deficient in calcium and chromium. educate the public, we are leading the Low carbohydrate diets mean cutting charge to get the word out. Our big out an entire class of foods. You are deficiency goal is micronutrient awareness.” losing and reducing all the micronutrients found in those foods commonly attributed to Dr. Linus Mira’s Turn Around including B2, B9, calcium, Pauling PhD, two time Nobel Prize magnesium, and iron. Gluten free winner. Jayson and Mira discovered three diets are usually followed by those crucial steps to reverse her with celiac or who have gut issues to osteoporosis and in turn to reverse begin with, so they are already micronutrient deficiency into dealing with malabsorption. They micronutrient sufficiency for optimal also experience deficiencies in Micronutrients health. Step one: eat foods that are calcium, magnesium, vitamin D, iron, rich in micronutrients (the FDA has and B12. The vitamin B12 helps keep 1. Vitamins identified 27 essential the amino acid homocysteine at the micronutrients). Step two: drive right level, which may help decrease A. Water Soluble (C, niacin, down micronutrient depletion from the risk of heart disease and is thiamin, riboflavin, folate, B6, B12) your diet and lifestyle habits. Step essential to red blood cell production three: learn your ‘ABCs of (red blood cells carry oxygen B. Fat Soluble (A, E, D, K) supplementation’. through the blood to the body tissue).” 2. Minerals Switching to ‘micronutrient rich foods’ may sound simple enough Jayson published a study in the A. Major (iron, calcium, until you ask, “What are Journal of the International Society potassium, magnesium, micronutrient rich foods and where of Sports Nutrition (2010) where he phosphorous, sodium) do you find them?” Responses may compared four popular diets for 27 range from eat local, to eat organic micronutrients identified as essential B. Minor (selenium, zinc, and stay away from sugar. Adding to by the FDA for daily intake levels. chromium, nickel) the confusion, there are a plethora of He compared: The Atkins for Life diets to follow including vegan, diet, The South Beach diet, the Mediterranean, vegetarian, low DASH diet, and The Best Life diet.

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His results were remarkable. He demonstrated that: the Atkins diet was 44% sufficient and provided 100% RDI for 12 of the 27 essential micronutrients analyzed the South Beach diet was 22% sufficient and provided 100% RDI for 6 of the 27 micronutrients analyzed the DASH diet was 52% sufficient and provided 100% RDI of 14 of the 27 micronutrients analyzed and the Best Life diet was 56% sufficient and provided 100% RDI for 15 of the 27 micronutrients analyzed. Furthermore, the standard over-the-counter medications. I American diet is composed of mean, if you’re living in LA, you’re Over all, his study found that “the “Naked Calories”, according to the not going to move, but we want typical dieter following one of these Calton’s, meaning we eat foods that people to be aware that air pollution diet plans would be 56% deficient in have been stripped of their depletes micronutrients, and you will obtaining RDI sufficiency, and they micronutrients due to farming require more antioxidants living would be lacking in 15 of the 27 practices, processing, and there.” essential micronutrients” (Calton, manufacturing processes, and even 2010, p. 7). ways of cooking (e. g., microwaves, The ABCs of Supplementation: deep frying). We need to make The Science and the Art “Micronutrient sufficiency needs changes, they say, in what we eat and to come first and then let your diet how we live in order to decrease “We are food first people, and we philosophy follow behind,” Jayson micronutrient saboteurs. are realists, we’ve done the says. research,” Jayson says. “You cannot “We want to educate people in the get enough micronutrients on a day- Micronutrient sufficiency relies on grocery store where they are face-to- to-day basis without food quality. Eating foods with face with food,” Mira says, supplementation.” genetically modified organisms explaining the motivation for their (GMO) such as corn, soy, milk, second book entitled, Rich Food, Basically, 50% of the US sugar beets, cottonseed, alfalfa, Poor Food. “Most people go grocery population pops a daily multi- canola oil, and aspartame may lead shopping looking for what’s on sale, vitamin; however, about 80% of the to toxic side effects; the genetic which brand is cheaper, and what micronutrients in those pills are not material (DNA) in these foods are they have coupons for. We want to absorbed. With this knowledge in altered in ways that are not naturally let them know what the words mean mind, the Calton’s created a occurring. There is no common at the end of the list of ingredients multivitamin powder, Nutreince, consensus on their safety: “Different and what they are doing to their based on what they call the ABCs; GM organisms include different health. There are a dozen everyday absorption, beneficial qualities, genes inserted in different ways. This micronutrient-depletion-stealth- competition and synergy. means that individual GM foods and habits that deplete the micronutrients (for a complete discussion visit: their safety should be assessed on a we have already have eaten. Things www.ABCSofsupplementation.com). case-by-case basis and that it is not we do every day. We look at what’s possible to make general statements in the foods we are eating like oxalic A is for Absorption. Most vitamins on the safety of all GM acid, tannins, stress in our lives, even come as a coated pill or tablet, or in foods’ (Retrieved from http:// exercise. It’s supposed to be healthy, chewable or dissolvable form. Pills www.who.int/foodsafety/ but it subtracts from our daily are difficult for the intestines to publications/biotech/20questions/ micronutrient sufficiency. We need break down and absorb. Many pills en/). to drive down depletion. We look at add sugar to make them more

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palatable but sugar blocks the not just light that causes the Vitamin E comes in several forms. If absorption of vitamin C, calcium, and breakdown, air does too. Each time there’s a dl- before your vitamin E on magnesium. There are also many you open the container air enters the label that means it is the cheaper hidden binders, fillers, and flow creating oxidation. synthetic form. The Calton’s stress agents in pills to make them easier for that you want the natural source, manufacturing. And, they are often “I was taking handfuls of pills all which is better retained and coated with shellac or wax to keep day, before and after every meal,” biologically active. You want your E the moisture out of the pill but this Mira says, recalling when she was to have both tocopherols and decreases its solubility in the body. first starting her healing process. tocotrienols for the full spectrum. Artificial colors are added, which “Some of them were horse pills, and Folate (aka vitamin B9), needs to be have been linked to cancer and they were gaging me. I was not about in the form of 5- require warning labels in other to take 10,000 pills a year for the rest methyltetrahydrofolate (5MTHF) for countries, including Blue 1 and 2, of my life, so we created Nutreince (a the best conversion. And vitamin K, Red 40 and Yellow 5 and 6. Many single serving, in powdered form, in which is important for blood clotting, multivitamins also have BHA and foil, that, when added to water is is usually given as K1, if even BHT added, which are known to be highly absorbable).” included at all. However, it’s K2 that carcinogenic. aids bone mineralization and is not “It was born of necessity,” Jayson often in multivitamins. A Harris Interactive® online study says. “It’s part of our story. It’s who (2003) also found that 40% of we are. We spent years researching it. “Some studies are saying women American adults have difficulty We researched all the other over the age of 50 should not take swallowing pills and thus avoid multivitamins, and if one had met our calcium supplements. The doctors are taking them. Those with irritable guidelines we would have used it.” reading the studies that say calcium bowel syndrome, hernias, and creates a build-up in the arteries, but diverticulitis also have difficulty B is for Beneficial quantities. The if you have vitamin K2 in the body, it absorbing pill-form nutrients. It is amount of each micronutrient in your will pull it out of the arteries and help better to drink your supplements, but supplement as well as the form and it absorb into the bones. If more there’s concern in terms of storage grade that it comes in to achieve people were sufficient in K2, we and integrity of the nutrients. Just like minimal sufficiency is important. would have fewer bone breaks. You milk needs to be in an opaque There are high grade and low grade don’t want to stop taking calcium container to maintain its health forms of each micronutrient supplements—that’s not the solution. qualities, micronutrients are depleted manufactured. When your After all, where would you get your by temperature, light, and air. multivitamin says vitamin D—you calcium from? People think spinach. may be getting D2 or D3. “You may However, spinach has 280 mg in a 10 Buying vitamin infused waters in be paying for a Porsche but -ounce package, but the naturally clear plastic does not help. And it’s purchasing a Hugo,” Jayson says. occurring oxalic acid in the spinach

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“You can’t just take one vitamin. It will backfire. Micronutrients are like a symphony— all the players are needed. You can’t have just one instrument to create a harmonious sound.”

binds with it so only 28 mg is Jayson says. “There may be mercury the amount of vitamin A you take in. absorbed. It also binds to other in fish but if you have selenium, They all work in unison.” important micronutrients in your vitamin C, and vitamin E in your food, too, like iron and magnesium.” system they will draw the mercury C is for Competition. Mineral Jayson says. out so it can’t stay in the body. This competition is the game changer, the is a reason we should chose to eat Caltons’ say. “Micronutrient Timing matters as well. Not all fish that are selenium rich. antagonists are the single most vitamins and minerals are absorbed Micronutrients are natural important reason multivitamins equally. Water soluble vitamins such detoxifiers. Vitamin D increases the cannot deliver the benefits of the as vitamin C and the B vitamins are absorption of calcium, and vitamin,” they say. They spent over absorbed and excreted via our urine magnesium, and if you are deficient six years mapping out all of the about every 12 hours. Unless vitamin in either of these vitamin D will work competitions that they could find C is taken twice a day, you are not to increase lead” (resulting in lead proof for in peer reviewed literature. going to fully realize its benefits, the toxicity) (Watts, 1990). They wanted two separate authors to Caltons’ say. Fat soluble vitamins have found the same information. (A, D, E, and K) can be stored in the “You can’t just take one vitamin. It Forty-five competitors have been body and have limited absorption will backfire,” Mira says. well established. The Caltons’ even rates. The Caltons’ say that taking “Micronutrients are like a got a US patent for their ‘anti-mineral your multivitamin twice a day with symphony—all the players are competition’; it’s the first time a the right combinations and amounts needed. You can’t have just one formulation patent was given for is essential for healthy body instrument to create a harmonious supplements, Jayson says, explaining functioning. sound. If you just take vitamin D, that most patents are given for the you get more issues. Vitamin D and delivery system for example: time “Micronutrients will chelate with Vitamin A are antagonists. You can release, capsule, tablet, coating. different heavy metals and toxins,” cause night blindness if you reduce

“We say you can yell at two kids to keep quiet, but it will not happen unless you split them into separate rooms,” Mira says. But they reversed her osteoporosis, which is unheard of they say, by creating their unique multivitamin.

It turns out that the body is limited in its ability to absorb all the nutrients in a multivitamin all at once. They compete for receptor sites, and there can only be one winner. The Caltons’ explain that there are four times when competition occurs. First: a chemical competition occurs during manufacturing. For example, Zinc is insoluble with B9 in the same mix— when together, neither are absorbed. Second: a biochemical competition occurs after the vitamin is ingested, it may or may not be absorbed at the receptor site. Third: a physiological

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“You can get healthy through many dietary pathways; there is no one right diet.” competition occurs after the utilization of other nutrients. Watts when they aid the performance of the micronutrient has been absorbed—it (1990) noted a hypothetical case: a other in the body; and clinical can cause decreased utilization of patient with osteoporosis may be synergy occurs when they are found other micronutrients. Fourth: a consuming 800 to 1,000 mg of to work together in observable and clinical competition takes place calcium without appreciable effects. yet unexpected ways. where its presence in the body masks The doctor may up the dosage to the presence of other micronutrients. twice even three times that and will “You have to use anti-competition In fact, the supplement you are taking see results, until the supplementation and synergy,” Jayson explains. may be getting in its own way. ends. The patient returns to the pretreatment state. If the competitors “This is a huge paradigm shift—to For example, a woman over the age and depletors (vitamin E, vitamin A, look at the way micronutrients in of 50 is supposed to get 1200mg of potassium, and phytic and oxalic supplement form will have more calcium daily. But the body can only foods) were deleted as well as adding benefits if we understand the absorb up to 600 mg at a time. The in synergists, (vitamin D, magnesium, competition,” Mira says. quality of the calcium taken is copper) the patient would respond to important as well as not being 400 mg of calcium. The Calton Project leached from the bones or chelated in some way. If K2 is there, calcification S is for Synergy. As Watt’s (1990) Along with intense and in-depth will not take place. But, calcium is noted, and the Caltons’ explain, the research, the Caltons’ nutritional also antagonistic to zinc (it decreases opposite of competition is synergy. concepts were also derived from the absorption of zinc creating a The Caltons’ looked at what living with indigenous tribes for six deficiency); vitamin D increases micronutrients worked best together years. Their honeymoon, actually, calcium absorption, which again, in to increase absorption (Watts, 1990). was spent traveling to 100 countries turn, suppresses zinc absorption They researched which on 7 continents to observe the eating (Watts, 1998, 1990). Taking too micronutrients were best suited for patterns of indigenous tribes and to much calcium, and/or taking it in one another. Just as competition takes learn about their nutritional conjunction with zinc will inhibit our place four times, they found synergy philosophies and their impact on zinc absorption. occurs four times. Chemical synergy heath. occurs when some micronutrients Some doctors may address form an advantageous complex; “There were so many different competition by having patients take biochemical synergy occurs when tribal cultures, so many different mega doses of single vitamins. But they aid in the absorption of one styles of diet,” Jayson says. “You can these high doses interfere with the another; physiological synergy occurs get healthy through many dietary pathways; there is no one right diet. We noticed that the diet of healthy people fluctuates with the seasons. They are surrounded by micronutrient rich food; they are micronutrient sufficient at the core of nutritional health.

“All sciences have laws,” he continues. “There are chemical laws, physics has its laws, but nutrition doesn’t seem to have any laws. It’s like the Wild West. We want to create a law that states that micronutrient sufficiency is mandatory to establish optimal health. It is a universal truth that is applicable to all diet philosophies. The truth is, we have people who are sick and fat because of micronutrient deficiency.”

The Calton Project: Photo courtesy of Mira and Jayson Calton. Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 20

Obesity the signals their body sends. It’s a currently sits on the American Board of physiological craving and you have Integrative Health. Mira's interest in According to Jayson, the current to get rid of that. We are looking in nutrition came after having been contemporary theoretical perspective the exact opposite direction. Low diagnosed at the age of thirty with of obesity is that people are calorie diets, diets that restrict intake advanced osteoporosis. Working with her husband Dr. Jayson Calton to become undisciplined, lazy, or are overeaters. of food groups, such as gluten or fats, micronutrient sufficient Mira reversed It’s time to consider it biochemically, take away the foods you are getting her condition, they now work together to he says micronutrients from. You are taking inspire others to do the same. out the B vitamins that in turn help us “There are people who have lost get the minerals and vitamins out of Jayson B. Calton, PhD, FAAIM, their weight. They look better, feel the food derived them. We need to DCCN, CMS, CISSN, BCIH, ROHP is a better. They are out buying new derive and utilize micronutrients. Fellow of the American Association of clothes. They achieved the look they Many nutritional approaches today Integrative Medicine, a Diplomate of the wanted. You would think they should block our ability to do that.” College of Clinical Nutrition, and is stay at that weight, with that Board Certified in Integrative Health and Sports Nutrition. He has worked with accomplishment,” Jayson says. “But They shared one last story while we thousands of international clients over there’s a voice in there saying eat were talking that typified their the last 20 years to improve their health those French friends, eat that ice presence in the field of through his unique nutritional and cream, go to Dunkin Donuts. They micronutrients and optimal health. lifestyle therapies. Dr. Calton majored in break down and eat. It’s not that they Mira explained that they still answer Molecular and Microbiology (pre-med), are lazy, it’s that their body is all of their emails and respond to the at the Burnett Honors College, School of overriding their brain. They are postings on their Facebook page and Biomedical Sciences and holds a Masters eating food because of micronutrient website. A 40-year-old women of Science degree and a Ph.D. in cravings, which goes away with contacted them. She was a triathlete, Nutrition. He has completed post- micronutrient sufficiency. We’ve a vegan. She having some health doctoral continuing medical education at Harvard Medical School, Cornell helped thousands of clients suffering problems. Her lab work showed a University, and Yale University School from cravings go from no control of high level of calcium and a low level of Medicine, and sits on the American their cravings to no cravings. They of vitamin D. She was reading their Board of Integrative Health (ABIH). become sufficient and now discipline book, Naked Calories, and realized and education are enough to maintain that she was eating foods high in References their weight loss.” oxalic acid, which was binding to the calcium and leaching it into her blood Agiratos, V. & Samman, S. (1994). The effect of calcium carbonate and calcium caltrate on “I used to eat gummy things all (thus high calcium levels in the lab the absorption of zine in healthy female day,” Mira says. “I went for Swedish work). She went to her doctor and subjects. European Journal of Clinical Fish for quick energy, but in truth I demanded a DEXO scan. The scan Nutrition 48(3), 198-204 was depleting the calcium from my diagnosed both osteoporosis and Allen, L., de Benoist, B., Dary, O., & Hurrell, bones. Now that I’m calcium scoliosis. She had already lost two R. (Eds.). (2006). Guidelines for food sufficient, I don’t crave sugar any inches of height. Their research, in fortification with mirconutrients. World more.” fact, saved her bone density, and their Health Organization/Food and Agricultural three-step process will be responsible Organization of the United Nations, 1-376. for her healing. Calton, J. B. (2010). Prevalence of micronutrient deficiency in popular diets. Journal of the International Society of Sports Mira Calton, CN, FAAIM, DCCN, Nutrition, 7, 24. CMS, CPFC, BCIH is a Licensed Certified Nutritionist, a Fellow of the Funk, C. (1912). The etiology of deficiency American Association of Integrative diseases. Retrieved from http:// Medicine, a Diplomate of the College of www.mv.helsinki.fi/home/hemila/history/ Clinical Nutrition, a Certified Personal Funk_1912.pdf

Fitness Chef and is Board Certified in Watts, D. L. (1990). Nutrition Integrative Health. She holds a Diploma Interrelationships: Minerals—Vitamin— in Comprehensive Nutrition from Endocrines. Journal of Orthomolecular “People are confused,” Jayson Huntington College of Health Sciences, Medicine, 5(1), 11-20. says. “They think it’s just a habit, and has completed the Yale University they can change a habit. But they School of Medicine's OWCH (Online Watts, D. L. (1988). The nutritional cannot change the actual cravings, Weight Management Counseling for relationships of zinc. Journal of Healthcare Providers) program, and Orthomolecular Medicine, 3(2), 63-68.

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Naked Calories

Rich Food Poor Food

Written by Jayson Calton, PhD, and Mira Calton, CN

Reviewed by Nancy Eichhorn, PhD

When people face life threatening activity, stress level, food shopping 100% RDI sufficiency with the and potentially debilitating diseases and preparation including cooking Practical Paleo diet you would have such as cancer and osteoporosis, techniques. Fortunately there’s no to consume 17,000 calories! There is when their health declines for reasons failing score, the outcome is an in-depth discussion on obesity and unknown (medical tests are awareness of how you may be sugar’s role in fat formation. And the inconclusive so doctors call it a depleting your micronutrients book ends with ‘The hypothesis of syndrome), when their emotional unknowingly and what you can start health’. There are 17 pages of well-being plummets as chronic pain to do to change course and prevent or references (in really small font size) and suffering lead toward traces of reverse disease. to support their data and claims. They depression, they may look for a way did their homework before offering out. The Caltons’ wrote their books The book includes information on their insights to the general public. after Mira was diagnosed with basic nutrition, vitamin advanced stage osteoporosis to share supplementation (the ABCs of Rich Food, Poor Food was written what they learned during their supplementation) and how in response to people needing journey to heal her. micronutrient depletion occurs. There guidance when going to the grocery are multiple causes of depletion such store (what are rich and poor foods). Naked Calories was written first to as prescription medications, toxic Thus, the Caltons’ created their own detail the three steps they discovered chemicals in foods, and antagonists GPS (grocery purchasing system) to that created Mira’s remarkable and synergists that block and aid guide their readers’ one aisle at a turnaround. There’s a quiz provided absorption. Furthermore, several time. This is a hands-on manual to to determine your micronutrient popular diets (Atkins, South Beach, guide readers as they move into a sufficiency levels because, “Statistics DASH, the Best Life Diet, Practical new frame of food awareness and cited by the United States Paleo, and the Primal Blueprint) consumption. Department of Agricultural indicate result in micronutrient deficient. The the likelihood that you are deficient Caltons’ did a comparison study and Both books are as flashy and in one or more of the essential documented which micronutrients are engaging as their authors, as jam micronutrients” (Caltons’, 2013, deficient and how many calories you packed with energy and movement p.22). The quiz considers all aspects would have to eat to reach 100% RDI and color and style as their authors, of our lives including nutrition, sufficiency; for example, to reach as easy to be with and follow and

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learn from as if you are hanging out as guide posts such as with Mira and Jayson walking around ‘Good In, Bad out’, ‘Steer grocery store aisles. The book covers Here (green and inviting), are glossy and thick and substantial; Steer Clear’ (red and the inside paper is glossy and orange indicating danger smooth—these books were made to as if the words are on fire), last. ‘Food for Thought’, ‘Checkout Checklist’, and The quality of professionals writing ‘No Taste Like Home’. their support for the Caltons’ is the The format becomes first indicator that you are about to routinized, known, making change the way you think and feel all this new data easily about food and micronutrients. New digestible. The York Times bestseller Anna Louise information is accurate Gettleman, PhD offers that “Naked and immense yet written in Calories deserves to become a a light and lively classic on par with Dr. Weston manner—there’s humor in Price’s Nutrition and Physical these books, they’re Degeneration” while Michael Holick playful despite the reality M.D., PhD (director of the Vitamin D of the intense nature of the Skin and Bone Research Laboratory content and its impact on at Boston University) writes, “Naked human health and Calories is a D-lightful expose` that wellbeing. The material is brings into focus the adage, ‘You are presented so that anyone what you eat.’” Support for Rich can understand regardless Food Poor Food is just as robust: of their background Jonny Bowden, PhD, CNS, author of experience with nutrition—these are download such as a small cheat sheet The 150 Healthiest Foods and The books for laypersons to bring home of “The Fab 14” and “The Terrible Great Cholesterol Myth writes, and learn from, these are books for 20” to bring along when you go “Finally, a book that tells you what practitioners to share with their shopping. The recipes are actually you really need to know to make patients (and perhaps learn from easy to follow with limited healthy food choices in the real themselves). ingredients; in fact, their philosophy world. An outstanding addition to adheres to the belief that less is any library” (Caltons’, 2013, p. xiii). There are checklists, shopping lists, more—the fewer the ingredients, the charts, recipes. Labels are revealed closer to natural and pure the better. The layout in both books invites with ingredients explained, defined. readers to interact with the material From milk and cheese to hot dogs The Caltons’ offer readers a via bold colors, stylistic fonts, color and chicken, from condiments to chance to revamp their diet and enter coding, and icons and symbols acting baking necessities, the Caltons’ share a new relationship with food that will their insights into the micronutrient have positive and lasting effects. I values of the very foods people highly recommend these books for consume—even Lays potato chips people looking to make dietary and their counterpart—healthier changes for lasting health. crisps—are exposed. They come forward with honest statements such as “don’t waste your money”, “The Fab 14”, and “The Terrible 20” so References readers know which fruits and Calton, J., & Calton, M. (2013). Naked vegetables they can purchase calories: The Caltons’ simple 3-step plan conventionally (cost less) and which to micronutrient sufficiency. Cleveland, they need to make sure are organic to OH: Changing Lives Press. reduce the risk of genetically modified organisms (GMO) and Calton, J., & Calton, M. (2013). Rich pesticide residue. They have multiple food poor food. Cleveland, OH: free resources on their website to Changing Lives Press.

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Turning-The-Tables

An Interview with Helayne Waldman ED.D., M.S., CNE

By Nancy Eichhorn, PhD

When her father was diagnosed with small-cell lung cancer in 1994, Helayne Waldman knew it was lethal. She researched ways to support his health and did the best she could considering she was a layperson, not a practicing nutritionist. A single mom at the time, Waldman worked as a trainer in field-readiness and marketing for a database firm. Her father died in four months, planting a seed that Waldman later nurtured into a healing profession for people living with and dying from cancer.

“It was quite traumatic,” Waldman career, and that she needed to Meeting during this initial decision says. “It was devastating to me to lose specialize in helping those with making process is actually a tricky my father and to watch what cancer. She did a ton more research time to connect. mainstream treatment did to him.” and helped to extend her friend’s life for another year with nutrients and “I have so many of my own biases A few years later a beloved aunt was supplements. Together, these against traditional treatment,—they diagnosed with cancer. Waldman experiences enabled Waldman to don’t know what they’re in for—I do. researched again, looking for ways to come forward with a deep, profound Chemotherapy, radiation, the drugs support her aunt’s health using passion for helping people through they use are carcinogenic—they lead nutritional means rather than rely their cancer, before and after to secondary cancer. My heart hurts solely on traditional medicine, treatment. She knows nutrition, and when I see women scared into knowing the devastation she has an intimate caregiver insight— something that may not be in their best chemotherapy and radiation create in she’s seen what happens in people’s interest, but it’s between them and the name of cancer treatment (the side lives, she knows the nightmares and, their practitioners (usually an effects often debilitating in in some cases, can make them less so. oncologist or a breast surgeon). It’s themselves). Shortly thereafter, not my place to talk them out of what Waldman felt her focus transition Client Care they and their doctor decide to do,” from training to teaching, from Waldman says. marketing databases to promoting The first step for Waldman is health and wellbeing. She had already knowing where clients are in their “I can educate them about the entered a holistic nutrition program stage of treatment—what has the basics of staying strong through when she learned that a dear friend client chosen to do? Some come in surgery. I can build them up for was diagnosed with a glioblastoma— preparing to have surgery. Some may surgery—make it easier to recover and an aggressive, fatal, brain tumor. have chemotherapy and/or radiation detoxify from the anesthesia. After Waldman knew at that point that slated for after surgery. Some come in surgery I can help speed up recovery nutrition was not just a passion but a post-surgery looking for support. with whole foods and nutrients.

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“There are many nutrients, herbs, supplements, and whole foods that can help women through their journey. My role on the team involves helping to mitigate the side effects of traditional treatments by keeping the body as strong as possible.”

If they are going for chemotherapy, non-target tissues that are getting hit. “There are many nutrients, herbs, I can help mitigate the immediate and For example, mung beans contain supplements, and whole foods that long term side effects and help vitexin (a naturally occurring flavone can help women through their maintain blood counts— C-glycoside and lignan compound journey,” Waldman says. “My role chemotherapy and radiation cause identified in various plant sources) on the team involves helping to white and red blood cell counts to and isovitexin that have been shown mitigate the side effects of traditional drop drastically. I can help maintain to induce apoptosis (a normal treatments by keeping the body as an appetite, quell nausea, support physiological process designed to strong as possible. more energy, and manage the side eliminate DNA-damaged cells and effects of neuropathy (chemotherapy unwanted cells; when halted it may “After treatment, we try to make damages nerve cells resulting in loss result in uncontrolled cell growth and sure there is no recurrence. If they of sensitivity of touch, pain, burning, tumor formation) and suppress tumor come in DCIS or stage 1, then the and tingling in the hands, fingers, growth. Mung bean anticancer effects cancer has been caught early. If it’s a feet and toes, muscle weakness and have been demonstrated against tiny lump, they may have a balance problems, and cramping in hormone-related cancers (Yao, lumpectomy and nothing else. We the hands and feet).” Cheng, Ren, 2011; Cheng, Shan, can change the terrain in the body so Ren, Chen, & Wang, 2008). And that it is no longer hospitable to a High doses of radiation are used to studies have also shown that eating cancer growing there. We need to kill cancer cells but it also damages some form of mung beans on a daily look at the parameters of what is healthy cells in the treatment area. basis helps stop blood counts from going into their body that made it Side effects are noted as itchy, dropping as much and wards off hospitable to cancer cells and then peeling, blistering skin, fatigue, fatigue. work to alter that terrain. diarrhea, nausea and vomiting, and swelling, with later side effects “The real art comes in knowing Changing the Terrain ranging from joint pain and which food for which condition,” lymphedema to secondary cancer. Waldman says. She mentions miso Waldman focuses on toxins and Waldman knows which foods are and black cumin seed to mitigate the ways clients can reorganize their radio protective and can protect the effects of radiation damage and lives to avoid many toxins. For protect normal healthy tissue. Miso starters? Personal care products such (fermented soy bean paste) has as makeup, shampoo, and lotions radioprotective effects, and it also have phthalates and parabens in them contains the phytochemical genistein that are endocrine disrupting that cuts off blood flow to cancerous chemicals. Antiperspirants have tumors (anti-angiogensis); it basically aluminum in them. It’s not hard to suffocates the tumor (Watanabe, change to coconut oil, Waldman says, 2013; Ohara et al., 2001). There are noting that it is a better moisturizer, a topical gels and ointments derived better emollient. She looks at what from flowers such as calendula people can get out of their life that officinalis (common name marigold) they have some control over. We that include lutein and beta-carotene. have no control over many toxins she Calendula extracts have demonstrated says, even organic foods are tainted anti-inflammatory properties as well with heavy metals. as antibacterial, anti-parasitic, and anti-tumor properties (retrieved from Waldman works with clients to www.mskcc.org/cancer-care). enhance the body’s ability to Women can spread it on their breast eliminate toxins. She can support the to soothe radiation burns, Waldman liver, explaining that if there is a big says. traffic jam in the system, the body

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will not function well. For instance, if sugar managing minerals (interacting you are not having a bowel with insulin). While vanadium has movement every day those toxins are not been established as an essential being stored, primarily in fat micronutrient in our diet, biological (adipocytes). Fat cells, especially effects such as insulin-mimetic action abdominal, issue distress signals have been discovered and multiple sending local immune cells into biochemical and molecular actions action pumping out cytokines have been implicated in its inhibitory (immune system hormones) causing effects on various tumor cells of inflammation. “Inflammatory human origin. In several animal chemicals are like fertilizer for cancer models, vanadium that are your unique metabolic needs. cancer,” Waldman says. demonstrated protection against all She looks at high blood sugar, stages of carcinogenesis: initiation, insulin, inflammation. “We can use Another example Waldman offers promotion, and progression. herbs and supplementation such as involves sugar—it invites cancer (Bishayee, Waghray, Patel, & black cumin and turmeric—they are back. When people eat foods loaded Chatterjee, 2010). Monocropping powerful anti-inflammatories. Bitter with sugar, the body compensates for doesn’t help either—some minerals, melon is another food – a member of the high levels of glucose with high such as potassium and phosphorous the squash family often taken as a levels of insulin. Insulin is a high are put back in the soil with supplement – with profound glucose- level growth promoter for cancer as commercial fertilizers, but micro lowering effects, and a documented well as a potent inflammatory minerals are not; the soil becomes ability to down regulate the Her2Neu hormone. Waldman works with depleted. Our food is shipped long protein associated with some clients to get their insulin and glucose distances, microwaved, and boiled, particularly aggressive breast cancers. levels as low as possible so there are which all deplete the nutrients we So the last story is to take what we no excess inflammatory chemicals in need. know about herbs and spices that the blood stream. “Those chemicals have pronounced anti-cancer activity are welcoming to incipient cancer,” “I can take a look at a person’s diet and make sure they are front and Waldman says. and see what they are eating that is center.” helping to support health and what they are eating that depletes it.” And, there are broccoli sprouts. Waldman says. “Processed food is health depleting food. A pure whole food diet is essential; it underlies everything. You can take all the supplements you want, but they will not make a difference if you are eating the standard American diet. You have to get the junk out. Most things out of the ground that are natural and whole are good. But if She also looks at what nutrients her you are eating animal meats they clients are getting from their diet and have to be raised as they were meant Chemotherapy kills cancer cells but where they may be deficient. to be raised: if it’s a cow, it needs to not the cancer stem cells. Broccoli Nutrients that play a strong part in be eating grass; if it’s a chicken, it sprouts will kill cancer stem cells. anti-cancer treatment include the needs to be eating bugs. These While Waldman cannot claim 100% following: vitamin A; vitamin D; animals were not designed to eat stem cell death, research does show vitamin C; the mineral zinc; GMO corn and soybeans. What they that broccoli sprouts do kill cancer selenium; magnesium; iodine; and eat, we wind up eating as well.” stem cells, and they are a strategic trace minerals. All are potent addition to your diet. Dr. Paul protective nutrients. Her clients may Tests can determine vitamin D, Talalay, a researcher at John Hopkins not be getting enough from their diet zinc, iodine and magnesium levels. School of Medicine, demonstrated because our food is processed, Then, Waldman can fill in the gaps. that broccoli sprouts contained depleted, devitalized—they are grown “It’s like a house being built, story by powerful phytonutrients known as in depleted soils, Waldman says. story,” she says. “The foundation is sulforaphanes and glucosinolates, Chromium and vanadium, deficient in your diet, the second floor is your cancer fighting compounds that offer our soils, are our two main blood individual nutritional needs. Beyond 20 to 50 times more cancer fighting

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ability than from the mature adult help detect these tumors because the now is where I get to do my thing. broccoli plant (cooking broccoli or tissue is more highly vascularized. I’m in charge. I’m empowered. I can steaming for longer than 4 minutes Even if it is a tiny tumor, if it starts make myself better, keep myself destroys any cancer-fighting the process (known as angiogenesis) healthy. It’s all about empowerment. properties) (Retrieved from www.jhu.edu/ it will show up as a pattern of heat If I can help women to understand the jhumag.0408web/talalay.html). (excessive blood vessel activity). power that is in their hands, then I’ve There are even natural substances to done my job well,” Waldman says. The skin from red apples contains help block this process. Curcumin triterpenoids that either inhibit or kill and sea cucumber extract are just a cancer cells; they also help up- The flip side of empowerment, couple of them,” Waldman says. however, is responsibility. Waldman regulate maspin (a tumor suppressor co-authored, The Whole-Food Guide gene), which has strong anti- “Cancer cells are wily. They secrete for Breast Cancer Survivors: A proliferative effects on breast and chemicals that camouflage them from Nutritional Approach to Preventing prostate cancer cell growth, (Retrieved from www.sciencedaily.com/ the immune system. When you Recurrence, with Dr. Edward releases/2007/06/070601181005.htm) enhance the immunize system, Bauman. They write that eating a lot while the skins from lemons can help natural killer cells go after the tumor of sugar and processed foods will prevent cancer cells from clumping and get a little better at detecting it. contribute to cancer growth. Some together. There’s strength in numbers, Other substances can be used to help women may feel blamed as if they are but cancer cells cannot form a colony unmask cancer cells so they become responsible for their cancer. It’s not because the citrus pectin gets in the naked to the immune system; this is that you created the cancer, Waldman way of clumping, which inhibits another avenue we can use to make says, it’s that you have to take tumor formation, Waldman says. these rogue cells view-able, responsibility for what damage you detectable to the immune system. may have done to your body. There is “We can come from many different fine line between blame and directions: vitamin A and vitamin D “The point I am getting at is that responsibility. And when you take are differentiating agents. Cancer there are so many different control of your day to day habits, it cells can be almost generic in approaches that can be taken because becomes empowering. Neither nature—that is, they don’t have the we know what cancer cells do: we Waldman nor anyone else can wave a same cellular characteristics as the know they create a blood supply; we magic wand and make your cancer go cells of the target organ. Pathologists know they stick together; we know away but as human beings we have a grade cancer on how different a they make the blood thick—the will and can make dozens of small tumor’s cells are it is from those in viscosity helps them move. We know decisions every day on our own healthy tissue. If it is somewhat they secrete inflammatory chemicals. behalf. And that’s powerful, she says. different, then it is a low grade tumor. Fish oil decreases the viscosity of the If the cell is markedly different, if it blood. You can also use healthy fats “I couldn’t save my father, my is poorly differentiated, then that and oils (fish oils, walnut, flax, aunt Yetta, or my friend Kathleen. I tumor is more difficult to treat. coconut, avocado, and olive oil) to wish I knew then what I know now. I Vitamin A and vitamin D help from help modulate inflammation levels.” could have made them more that perspective by coaxing the cells comfortable,” Waldman says. “But to move back to a state closer to a Self-Care in Cancer Care those losses did move me out of work normal cell. that held little meaning for me. I feel “Cancer survivors tend to fall into now that I am serving. I have a “It’s like the spokes of a wheel with the group of feeling victimized with a mission, and maybe I’m supposed to cancer at the center. We find every ‘poor me’ feeling that I completely be fulfilling it here. That is possible angle we can around that understand. But, I want people to satisfying.” wheel to come in and make it harder know they are so much more for cancer to do its thing,” Waldman powerful than they think. The fact is, You can find Helayne at the only person who can save you is www.wholefoodguideforbreastcancer.co says. m or on Facebook at Whole Food Guide you. Even if you believe in conventional treatments, they only go for Breast Cancer. Interested clients may “If a tumor has grown over 2 want to review her practice website at millimeters, it needs nourishment. It so far. And after you are done with www.turning-the-tables.com sends the word out signaling to treatment, your doctors may simply recruit blood vessels to form a say, ‘Okay, the cancer is gone, go Dr. Helayne Waldman, ED.D., M.S., network around it to feed it. have a nice life.’ There is such a need CNE, is a holistic health educator who Thermography works brilliantly to for women, in particular, to feel like specializes in providing nutritional continued on the bottom of page 29

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Written by Edward Bauman, MEd, PhD

and Helayne Waldman, MS, EdD

Reviewed by Phillipe Kleefield

Dr. Edward Bauman and Dr. Helayne Waldman, have chapters are important for understanding the science written a book mainly addressed for women currently behind why a particular emphasis is being placed on diet. living with breast cancer; however, the book is also written for women who may want to protect themselves The rest of the book is devoted to addressing specifics from developing the disease. In this book, The Whole within the diet plan recommendation and other ways in Food Guide For Breast Cancer Survivors, the premises which emerging risk factors might be avoided. Chapter supporting the lifestyle recommendations involve a belief three outlines the foundational diet plan, offering general that nutritional and spiritual factors are key components guidelines including growing your own salad green and of overall wellness, especially in preventing and herbs, drinking plenty of filtered water, reading labels and surviving breast cancer. Based on these premises, a avoiding foods with artificial ingredients, eating more comprehensive overview of diet, avoidable exposures, vegetables, consuming breakfast before 10 AM which and other factors are explored, including thorough should include a serving of goof quality protein, and other explanations of and sample recipes to truly make this general recommendations. In addition, each nutrient that change stick. is recommended is explored in terms of what it is, what it does for the body, and why it is being recommended in a The first and second chapters set up the book’s particular serving. In chapter four, the purpose is to theoretical foundation as to why diet and spiritual health understand how to limit your exposures to toxins. The are so important. These two chapters review traditional chapter explores the role of personal care products in the risk factors that have been established to play a role in the exposure of toxins, the toxins in water, general sources of development of breast cancer, including various genetic pesticides, and tips on minimizing these exposures. The factors, various hormonal factors, and confirmed fifth chapter is aimed at understanding the various environmental factors. The second chapter, the crux of nutritional deficiencies that exist, how to go about the foundation that supports Waldman’s argument, figuring out if you are suffering from any of them, and explores emerging risk factors in the development of how to go about creating a balance. These chapters are breast cancer, including “The Standard American Diet”— useful in getting a specific idea of what diet to eat to a Western dietary pattern that consists of a high intake of factors. red meat, sugar, trans fats, high-fructose corn syrup, artificial sweeteners, and refined grains (alcohol The next three chapters address glucose and insulin consumption in western countries), immune system control as it relates to weight, how to nourish and deficiencies, a chronic inflammatory state in the body, maintain your immune system, and minimize your breast iodine issues, and other similar risk factors. These two cancer risk, and how to reduce chronic inflammation. In

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the sixth chapter, higher glucose and important role in health insulin levels are seen as negative, functioning. Chapter ten goes reasons are explored as to the through a list of different relationship between insulin and hormones that may play a role glucose levels with cancer in cancer and examines how development, and lastly, different these hormones can be balanced strategies are offered to minimize to maintain an optimal interplay these levels. The seventh chapter in your body. These two addresses the immune system: the chapters are important in that importance of maintaining a strong they serve as a further immune system; how a strong supplement to the foundational immune system can be maintained; diet outlined. and an overview of the specific nutrients that are related to a good immune function. The eighth chapter Edward Bauman and Helayne addresses chronic inflammation and Waldman have written a book is aimed at minimizing it by that explores emerging risk assessing your current inflammation factors related to the levels and providing a thorough development of breast cancer overview of how inflammation can and how these factors might be be minimized in the body. These eliminated. Through a blend of chapters are important supplements practical schedules, scientific to the foundational diet and are literature supporting the various thought of as important in recommendations, and understanding the development of straightforward language, The breast cancer. Whole Food Guide for Breast Cancer Survivors is a great read for anyone pursue either a PhD or a PsyD degree. He The last two chapters address who is interested in making serious enjoys reading, especially books that are issues of digestion, elimination, and lifestyle changes. psychologically oriented. Before detoxification of toxins, and the role attending this program, he worked in the field of social services as a Case of hormones in the body. Chapter Phillipe Kleefield is currently a student Manager. Phillipe graduated from Vassar nine is an examination of digestion at New York University where he is College in May of 2009 where including its importance in health and pursuing his Masters of Arts degree in academically he studied sociology and how it can be optimized, and an General Psychology. He is interested in neuroscience, and was active in LGBTQ exploration of the liver and its clinical psychology and would like to student events and programming.

Waldman continued from page 27 Economics and Business Administration M. (2010). Vanadium in the detection, prevention and at Bauman College). She is currently and treatment of cancer: The in vivo evidence. Cancer Letters, 294(1), 1-12. doi:10.1016/ support for those with breast cancer. She a faculty member at Hawthorn j.canlet.2010.01.030 received her doctorate from the University. Dr. Waldman has written for certificate in holistic nutrition at Bauman several publications and online sites Cornell University. (2007, June 3). An apple peel a University of San Francisco, her MS including a regular column for the Hills day might keep cancer at bay. ScienceDaily. Retrieved March 13, 2014 from from the University of Albany, and her Newspaper Group, as well as the www.sciencedaily.com/ College of Holistic Nutrition. She’s Examiner, Green Medicine Info, the Pink releases/2007/06/070601181005.htm spent the past seven years teaching her Paper and others, and has spoken and clients, her students, and the general exhibited at conferences nationwide. She Ohara, M., Lu, H., Shiraki, K., Ishimura, Y., Uesaka, T., Katoh, O., & Watanabe, H. (2001). public about the importance of healthy is currently a board member with the Radioprotective effects of miso (fermented soy eating, and recently completed (with Dr. Annie Appleseed Organization, a bean paset) against radiation in B6C3Fi mice: Ed Bauman) the long awaited Whole member of the Survivorship Committee increased small intestinal crypt survival, crypt Food Guide for Breast Cancer Survivors, at Alta Bates-Summit Hospital, and a lengths and prolongation of average time to death. Hiroshima Journal of Medical Science, 50(4), 83- a guide to living well before and after a nutrition consultant to Bay Area Breast 86. cancer diagnosis. Dr. Waldman has Surgeons. taught for over 25 years (San Francisco Watanabe, H. (2013). Beneficial biological effects State University, Mills College, St. References: of miso with reference to radiation injury, cancer and hypertension. Journal of Toxicologic Mary’s College, Helskinki School of Bishayee, A., Waghray, A., Patel, A., & Chatterjee, Pathology, 26(2), 91-103. doi:10.1293/tox.26.91

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Food for Thought: You Feel What You Eat

An interview with Merrily Kuhn, RN, PhD, ND, PhD

By Nancy Eichhorn, PhD

'Let food be thy medicine and medicine be thy food'.

Today’s researchers and health care professionals are realizing the importance of Hippocrates’ early pronouncement as they investigate associations between precursors and cures for what ails our population.

Mood disorders such as depression, anxiety, panic our feelings of satiation and satiety that lead to attacks, along with gastrointestinal related syndromes overeating. These food sources also stimulate our desire (irritable bowel syndrome, eating disorders), obesity, to eat and the types of food we prefer (Sclafani, 2013). chronic pain, and concentration issues and related And while it is well known that negative feelings trigger memory loss are on the table. Food—the quality of our the desire to eat, research now shows that positive diet and the feelings related to what we eat, when we eat, emotions also trigger unhealthy food intake (Evers, why we eat—and what happens with the ingested Adriaanse, de Ridder, & de Witt Huberts, 2013). nutrients—the gut-brain-microbiota axis—are under microscopic exploration as researchers scan for new Our daily dietary choices can and do alter views on eating and its disorders. One focus is to create a concentrations of neurotransmitters in our brain and blood continuum from healthy eating practices to disordered (plasma), impacting their synthesis and release. A good eating behaviors while researching the affects in the example involves serotonin. Low levels of this human body (McMartin, Willows, Colman, Ohinmaa, neurotransmitter are associated with depression and Storey, & Veugelers, 2013; Muele & Vogele, 2013). anxiety. Although 90% is produced in our gut, its synthesis in the brain is bound by the availability of its Mood and Food precursor, tryptophan (a nonessential amino acid), which alters neural processing in mood regulating neurocircuits Brain chemicals such as neurotransmitters (e.g., (Kroes, van Wingen, Wittwer, Mohajeri, Kloek, & dopamine, acetylcholine, and serotonin) influence what Fernandez, 2014). Ingesting a carbohydrate-rich (and we think and feel and how we behave. Most people protein-poor diet) increases brain levels of tryptophan, accept that fluctuations in blood sugar levels result in which triggers an increase in serotonin production. changes in mood and energy; but new research now Although the carbohydrates themselves do not contain shows that sugar-rich as well as fat-rich foods actually tryptophan, the food intake triggers insulin secretion, override the hormonal and neural signals responsible for which in turn “decreases plasma levels of large neutral

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amino acids that would ordinarily sinusitis. It all comes down to the compete with tryptophan for gut. You can throw drugs at the transport across the blood-brain brain, but if the gut is not healthy, barrier. Resulting brain changes in those drugs have little likelihood of serotonin provide a plausible being effective. A vast number of mechanism whereby diet affects doctors still think leaky gut is still It all comes behavior” (Spring, 1984). But not an approved medical diagnosis. reaching for a handful of crackers is It’s difficult to test for, but now not the answer. You need to consider there’s one test (an Intestinal down to the homeostatic balance—low or high Permeability test) that can diagnose levels of neurotransmitters and/or leaky gut. Until that was developed, hormones result in physiological and it was diagnosed via symptomology. behavioral changes. For example, It’s easier for the doctor to say you’re gut. You can low levels of norepinephrine are depressed go see a therapist.” associated with loss of interest, poor memory, depression, and ADHD, According to Kuhn, health care while high levels are associated with professionals, including throw drugs anxiety disorders, an increased sense psychotherapists, need to take a “gut of arousal, panic attacks, and appetite history”, which begins with asking suppression. Dopamine causes a questions such as, what do you eat, natural high while low levels lead to but also includes asking about at the brain, loss of energy. But balancing clients’ stools. “Does it float? Sink? dopamine, serotonin, and What letter of the alphabet does it norepinephrine is not enough represent? If it’s a period, you’re in according to Dr. Merrily Kuhn (a trouble; if it’s an S-shaped stool, but if the gut naturopathic physician with that’s great,” Kuhn says. “It needs to doctorates in physiology, fill the bowl. If you constantly have a naturopathic medicine, and holistic small stool, you have to wonder is not medicine). You also need a consider what’s happening to the food and glutamate (AA) and acetylocholine toxins you are eating?” (ACH) and how they interact with the other neurotransmitters. “But, who’s going to talk about healthy, this?” Kuhn says. “Your clients come in with foggy thinking, short term memory issues. “No one,” she replies. “But it’s They can’t concentrate; they’re important. Where are the food and those drugs depressed, anxious, hyperactive. toxins going?” They have ADHD, ADD, chronic pain, chronic sinusitis, seizures. This An initial place to start, Kuhn says, probably describes most of the is to have clients keep a detailed food have little patients we see,” Kuhn says. journal for three to four days noting “Doctors order anti-depressants, everything eaten (when, what, and which probably do not work because the amount), so you have a better it is a gut issue. Most, if not all, of handle on what’s going on. But if likelihood of these complaints are caused by a someone writes down she ate leaky gut (the gut wall is damaged so macaroni and cheese, you have to that toxins leak into the vascular ask, was it homemade or Kraft? You system and travel to the brain). A want to look at what toxins they’re being leaky gut causes a leaky brain. Leaky exposed to as well as genetically brain symptoms include: memory modified and hybrid foods. The most loss, foggy thinking, depression, common foods and drinks associated effective. anxiety, chronic pain, poor short- with adverse reactions include: term memory, difficulty wheat, sugar, caffeine, dairy, concentrating irritability, artificial additives, and hydrogenated hyperactivity, achy all over feeling, fats. Furthermore, adverse food ADHD, seizures, and chronic reactions in the prenatal and postnatal

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phases of development are now taking these supplements. Did a irritable or aggressive feelings, thought to be related to attention friend tell them about it? Was it concentration, memory difficulties, deficit hyperactivity disorder recommended by a health care premenstrual syndrome, obsessive (ADHD) and autism spectrum professional? What brand are they compulsive feelings, eating disorder (ASD) (de Theije, Bavelaar, taking and what dose? The average disorders, psychotic episodes, Lopes da Silva, Korte, Olivier, practitioner has no idea about good insomnia, fatigue, behavioral and Garssen, & Kraneveld, 2013). quality supplements,” Kuhn says. learning disorders, and seasonal “They need to go to affective disorders. Dietary supplements are also Consumerlab.com. Consumer lab important to track. Much information tests the quality of supplements. If What’s at the heart of our gut? is available on the role vitamins and it’s a good quality great; if not, why The microbiota-gut-brain axis minerals play in our diet. waste your money? Some Associations have been demonstrated supplements are even lacking the Our body is constantly between low levels of certain B ingredients listed on their label.” communicating with itself. For vitamins and schizophrenia, between instance, we have constant bi- low levels of zinc with eating Furthermore, supplements just directional communication between disorders, and between low levels of don’t cut it if you continue to put all the gut-brain axis and our central Omega 3 fatty acids with depression. the toxins in your system. “Toxins do nervous system through neural, Diets deficient in magnesium or high cross the brain barrier,” Kuhn says. endocrine, and immunological in glycemic load may lead to higher “Neurotoxins cause inflammation in pathways that influence brain plasma C-reactive proteins (a marker the brain, and if the brain is inflamed, function and behavior – they play a of low grade inflammation), which is all of its functions are going to be role in the regulation of anxiety, thought to facilitate the development different—as a whole the brain is not mood, cognition and pain (Cryan & of depression, while oxidative stress, thinking properly, not making Dinan, 2012; Louis & Flint, 2013; which is thought to induce neuronal hormones properly.” Stilling, Dinan, & Cryan, 2014). damage and modulates intracellular signaling, has been associated with “It takes a lot of work for “One hundred trillion bacteria bipolar disorder, depression, autism practitioners, but it is worth it,” Kuhn constitute the human gut microbiota and schizophrenia (McMartin et al., says, adding that changes in diet have with 1800 genera and up to 40,000 2013). shown improvements in mood species of bacteria, which possess swings, anxiety, panic attacks, food 100 times the number of genes in the “You need to ask why they’re cravings and addictions, depression, human genome” (Forsythe &

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Kunze, 2013, p. 33). vitamins, minerals, and essential interventions in reducing anxiety, amino acids responsible for these decreasing stress responses, and The composition of our gut changes? improving mood in people with microbiota is individualized, irritable bowel syndrome and chronic although we share some common Research has shown that tyrosine fatigue (Cryan & Dinan, 2013). Do bacteria. It influences our normal increases the synthesis of dopamine we send our clients packing for physiology and contributes to our and norepinephrine, and it has been yogurt? diseases, from stress related disorders proven effective in fighting stress, (depression, anxiety, IBS) to and improving mood and cognitive Sure, yogurt is a great source for neurodevelopmental disorders performance especially in sleep probiotics, but Dr. Kuhn says to (ASD), food regulation, behavior and deprived people (Luckose, Pandey, & make sure it is yogurt. “There should mood. It impacts our immune, Radhakrishna, 2013). So do we be 3 ingredients in your yogurt: milk nervous and endocrine systems simply have our clients avoid sugar, and Lactobacillus bulgaricus and (Cryan & Dinan, 2012; Louise, & saturated fats, cholesterol, and Streptococcus thermophilus to be Flint, 2013; Stilling, Dinan & Cryan, refined foods that are known to true yogurt. Nancy’s Organic 2014). decrease dopamine while eating more Probiotic Greek Yogurts from Eugene, Oregon have these According to Linus two and five others Pauling (Nobel Prize Do we seriously send out clients out with probiotic bacteria (L. winner in chemistry), shopping lists that no longer represent the acidophilus, L. Casei, L. the human brain is rhamnosus, and B. more sensitive than foods they like and want to eat but rather bifidum). You want as many any other organ to account for their effect on our physiology? probiotics as possible,” she nutritional deficiencies says. She also recommends or imbalances. you always buy plain Dysfunctions in any yogurt, and stay away from part of the microbiota-gut-brain protein, almonds, bananas, dairy, fruited yogurts because of the sugars, communication system result in lima beans, and pumpkin and sesame flavorings, and colors that are added. pathophysiological consequences. seeds to increase their tyrosine? For example, “chronic stress alters “The bottom line is our very poor, gut microbiota composition; it Depressed? Buy foods high in manufactured food supply,” Kuhn disrupts the intestinal barrier making Omega 3 fatty acids (fish, ground says. “We all eat the same ‘stuff’ it leaky, which increases circulating flaxseed, hemp, or avocado oils) from the grocery stores. All levels of immunomodulates” (Cryan Stressed? B vitamins aid our adrenal manufactures are feeding us the same & Dinan, 2013, p. 704). Because glands in producing adrenalin, which food— 50 to 70% of our population alterations in our diet can result in controls the fight or flight response are eating white, fast, processed marked shifts in out gut microbial and helps to create serotonin so eat foods. If you go to the store and buy populations and dietary changes leafy greens, seeds, fish, poultry, and processed bread, there’s hair in it. L- influence behavior, modulation of meat. Magnesium is depleted when cysteine (a non-essential amino acid) our gut microbiota may offer a we’re stressed so add green leafy is a common ingredient in bread (it’s possible intervention for complex vegetables and pumpkin seeds to the added to the dough to speed up central nervous system list. processing, add texture, and improve disorders” (Cryan & Dinan, 2013; shelf life). Human hair is a cheap Forsythe & Kunze, 2013, p. 60). Do we seriously send out clients out source (hair is dissolved and L- with shopping lists that no longer cysteine is isolated through a Food for Healing: represent the foods they like and chemical process). They also add in Is it really that simple? want to eat but rather account for potassium bromate, a known their effect on our physiology? carcinogen, because it strengthens the It’s true that dietary changes dough and allows bread to be more trigger chemistry and physiological What’s Really in the Food We Eat airy (it causes the formation of tiny, changes within the brain that alter thin-walled bubbles as the bread our behaviors and emotions. But is it The probiotic lactobacillus species rises). There’s are also many enough to know which foods can strengthen the intestinal wall and chemical preservatives and stabilizers increase and decrease the levels of prevent leaky gut. Clinical evidence in processed foods.” the neurotransmitters, hormones, supports the role of probiotic

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“We need to encourage our clients shopping the perimeter of the grocery education and critical care nursing. She is to eat foods that do not have MSG, store. currently Education Director at Educational high fructose corn syrup, saccharine, Services. She was certified as a medical- or sugar alcohols. And what about “For the first month, I just suggest surgical nurse by the American Nurses added colors, dyes, and flavors? You they don’t shop in the middle of the Association for 20 years and was certified as have to stop and think, what’s the store,” Kuhn says to ease clients into a CCRN for 18 years. She has presented over 3200 continuing education programs across manufacturer covering up? What’s the change. “I say, don’t buy any the country and in 2013 taught over 19,000 being changed? All artificial colors, food in a box or can and see how it health care professionals around the county. dyes, and flavors are made from goes. Since the 1950s cans are lined petroleum—motor oil. Would you go with BPA, a known carcinogen. The She has authored more than 60 journal out of your way to eat motor oil?” FDA is just thinking about doing articles and has served on the Editorial Board Kuhn says. something. Avoid any processed of Critical Care Nurse, authoring a monthly foods. Have clients make homemade column - CCRN Challenge. She is the author “Would you drink flame retardant?” of twelve books, including Pharmacotherapeutics: A Nursing Process she adds. Approach, 4th edition, Manual of IV Drugs, nd 2 edition, Manual of Critical Care Nursing, Sodas and sports drinks, such as Complementary Therapies for the Health Pepsi, Mountain Dew, and Gatorade, Care Provider, Herbal Therapy & contain synthetic brominated Supplements, A Scientific & Traditional vegetable oil (BVO) to keep the Approach, 2nd edition, and Lab reference citrus flavoring from separating out. pocket guide. It’s banned as a food additive in Europe and Japan but not the U.S. It Dr. Kuhn is a member of Sigma Theta Tau and is listed in Who's Who in American contains bromine, an element found Women. She holds a B.S. from D'Youville in brominated flame retardants. It College, a M.S. in education and counseling does build up in the body and has from Canisius College, a M.S.N. and Ph.D. been associated with memory loss (physiology) from the S.U.N.Y. at Buffalo, and skin and nerve problems. and an ND (Naturopathic Doctor) and PhD According to Kuhn, the makers of (Holistic Health) from Clayton College. Dr. Gatorade made a public statement soup, freeze it in portions, so they Kuhn retired as a full professor from Lourdes that they were thinking about can have it easily at hand. Most University in Ohio. She continues to teach reformulating their product. prepared cereals are a no! Make your online at several colleges and universities own fresh oatmeal or experiment around the country teaching pharmacology, “Food is one of the most important with some of the new grains (quinoa, Pathophysiology and Complementary things to look at. If your diet is farro). Wheat berries cook in 15 Therapies. healthy, chances are you will be minutes and are great for your Dr. Merrily Kuhn healthy. If your diet is not healthy, morning cereal. It is excellent to eat EduServices you will have issues. If you need to cold with fresh fruit.” 6748 Boston State Road change, make a change for life,” Hamburg, NY 14075 Office 716 649-1350 Cell 716 491 9558 Kuhn says. “Eat more fresh fruits and [email protected] vegetables. Buy fresh, buy raw, and www. DrMerrily.org Yet it’s difficult to convince people make it yourself. It takes time, but to make a total life change. Our it’s healthier,” she says, then adds clients have eaten the same way their that it’s easy to say eat local when References entire life, but to address their you live in California, but if you’re de Theije, C. G., Bavelaar, B. M., Korte, S. mental, emotional, and physical living in climates with artic M., Olivier, B., Garssen, J., & Kraneveld, A. health concerns, the gut must be temperatures, if you don’t have D. (2013). Food allergy and food-based considered. Kuhn recommends eating access to gardens or greenhouses to therapies in neurodevelopment disorders. Pediatric Allergy and Immunology: Official as much organic foods as possible (as grown your own food then you are Publication of the European Society of much as you can afford). But make dependent on our food supply. “We Pediatric Allergy and Immunology. sure it’s labeled ‘100% organic’, she can only change,” she says, “if the says, otherwise it may still contain health of our food supply changes, Cryan, J. F & Dinan, T. G. (2012). Mind- pesticides, synthetic ingredients, and too.” altering microorganisms: The impact of the gut microbiota on brain and behavior. Nature genetically modified/engineered Reviews, 13, 701-710. foods. She also recommends Merrily A. Kuhn, PhD, ND, PhD, RN has Continued on page 110 over 40 years of experience in the field of

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New Open-Access Journal on Eating Behavior

Frontiers in Eating Behavior is an open- science on eating behavior as well as a strong IT focus, interactive peer access journal, launched in February clinical studies, human as well as animal review, and openness to numerous 2013. It covers diverse aspects of eating studies, and studies from psychological article types. Frontiers in Eating behavior and, accordingly, is listed as well as physiological and nutritional Behavior is indexed in PubMed Central, under a number of Frontiers Field perspectives. More than 100 scientists Scopus, Google Scholar, DOAJ, Journals: Frontiers in Psychology, from around the world are already CrossRef, and PsycINFO. For more Frontiers in Psychiatry, and Frontiers in involved as associate and review editors. information, please visit Nutrition. The journal, therefore, Frontiers is one of the largest open- www.frontiersin.org/eating_behavior. welcomes submissions from basic access publishers and sets itself apart by

The Mindfulness flexibility, is “being fully aware of and “pull” or compelled them to engage in and Acceptance open to [one’s] ongoing experiences as a certain eating behaviors. Workbook for fully conscious human being as [one] act Learning to accept experiences is Bulimia: A [s] in a way that serves [his or her] another important aspect of mindfulness. Guide to values” (p. 31). All of the concepts The authors use an interesting metaphor Breaking Free explored and exercises provided are of an uninvited guest who shows up to from Bulimia discussed in the context of these goals. one’s party to describe the presence of Using Acceptance This book consists of three parts that bulimia in one’s life. The idea is that and Commitment are further divided into chapters. Part ignoring this guest will only make him Therapy. One defines bulimia and explores its seem more annoying, giving him the three components: binge eating, upper hand. The authors suggest simply Written by Emily Sandoz, Kelly Wilson, compensatory behaviors, and body acknowledging and accepting this guest and Troy Dufrene image. The authors clarify that ACT is while carrying on with one’s party. not meant to directly solve any problems. Part Three serves as a review of the Reviewed by: Mona Zohny This section also provides a self- book. The authors suggest taking a break assessment for clients to determine their from the book at this point. In the The Mindfulness and Acceptance personal values. following chapters they discuss issues of Workbook for Bulimia is a self-help work Part Two is about mindfulness. The relapse and seeking support. The book - book designed for clients suffering from authors discuss the importance of being comes with a CD that contains audio bulimia. Emily Sandoz, Kelly Wilson, in the present and maintaining full tracks for the guided meditations and Troy Dufrene focus on acceptance awareness. They offer a guided provided in each section. and commitment therapy (ACT). The meditation to help clients notice and This workbook offers a counter- goal of this book is to help people with practice “being present” because intuitive framework for dealing with bulimia learn to accept themselves in mindfulness will prevent negative bulimia. The authors’ warm, friendly and order to live meaningful lives. The thoughts from lingering. The authors engaging tone helps to simplify complex authors emphasize two goals: valued dedicate a section on the “self-as- concepts. Their goal is for readers to living and psychological flexibility. context” that involves the reader learn to live a more meaningful life by Valued living is described as “patterns of discovering stories, or self-concepts, embracing their problem. The workbook action that put [one] in touch with [his or regarding his/her bulimia. Another then provides the tools necessary to her] values [things one cares about and guided meditation allows readers to reduce the behaviors associated with acts upon]” (p. 30). Psychological ruminate on stories that have created a bulimia.

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A Voyage into the Gut

By Stephanie Pollock, MA, CHC, EPC, CYT

My journey into the gut began at a very young age. My grandmother and aunt silently suffered with Crohn’s disease and ulcerative colitis my entire life. I was completely unaware of their digestive and bodily pain. My mother finally explained to me, when I was around the age of 13, why my grandmother was in the bathroom all morning on our family beach vacations and why my aunt’s health had declined over the years. So I have known and feared the possibility of having digestive troubles.

I was diagnosed with Irritable operate separately from the brain in weight gain. I have observed Bowel Syndrome around the age of our head (Gershon, 1998; Mayer, patterns within my clients and their twenty. When the doctors told me 2011). So your head might be relationship with food, and I have that there was nothing I could do and sending you messages saying one found that most individuals have not to just stay away from fiber, I thing, while your gut is saying been taught how to listen to the brain realized that this diagnosis of I.B.S. something entirely different. For in their gut (myself included). It took was, to be honest, BS. Thus began example, your head might be yelling me years to learn how to listen to my my journey into my bowels. If you at you, “I want chocolate, I want gut’s messages and that I was had asked me at that point in my life sugar, and I want cake,” while your digesting my emotions as well as my to imagine what my digestive tract gut is craving nutrient dense food (as food on a daily basis. Most of us looked like all I saw was black. A opposed to simple carbohydrates) have heard the colloquialisms, “I large black balloon was all that and high quality protein. I am not have a knot in my stomach” or “I existed in my gut. It was a saying that one message is better or have butterflies in my stomach.” We mysterious place that I didn’t not to listen to over the other, but eat our emotions almost every day, at understand. The only thing I knew they both offer information that we every meal. This is not a “bad” thing. was that I was angry and frustrated can utilize and learn from each time There is no such thing as emotional with my gut for failing to do the one we make choices on what to eat. Our eating because we are emotional thing I thought it was meant to do: food choices reflect our internal beings and we eat, thus eating will digest. Yet, I have learned over the physical and emotional state. always be an emotional experience. years that digestion is so much more than just how we digest our food. As a body psychotherapist and Our Enteric Nervous System is nutritional counselor, I have worked exquisitely designed and when given In our gut lies a second brain with individuals dealing with the chance, it knows how to digest called the Enteric Nervous System. digestive issues, eating disorders, our food, as well as our past and Some research suggests that it can body image issues, addiction, and present experiences. But pain,

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biological need for the wanted everything to slow down. It energy to function. wanted to be held, to be appreciated, Emotional hunger is felt to lie on the ground and feel the earth as emptiness in the body beneath it and know that it was being yet one does not need supported. There was pain in my gut food. Thus, no matter that went beyond the physical and how much food one eats when I finally did take the time to when feeling emotional slow down the emotional release hunger they will never happened bit by bit. I gradually began feel filled, satiated, to hear what it wanted to be fed. One nourished. The wires get day I spent until two o’clock in the crossed when it comes to afternoon committed to hear what my properly satisfying body wanted to eat. Did it want physical and emotional warm or cold? Smooth or chunky? hunger very easily and at Raw or cooked? It finally spoke. It a young age. This is was so randomly clear: baked because, in my opinion, asparagus. I laughed out loud. It was food is love. Food is one so simple, and I have no idea what of the first forms of love nutrients or qualities were in we receive from a asparagus that my body might have parental figure at the time needed in that moment, but it was of birth. Thus, for the rest crystal clear: my gut wanted a of our lives food can be vegetable; it wanted it baked; it connected to love. When I wanted something wholesome and began to understand this warm. suffering, and disappointment happen concept, I realized that every time I in life, and the body can put up strong sat down to eat, I brought along every It can be incredibly hard to hear protective walls. It was those idea of love and nourishment I had these messages when we are protective walls that needed to come ever received. Food is not just food, bombarded by external information down for me to be able to get into my and a meal is not just a meal. It is telling us what to eat and what will gut and release the pain held there. possible to tap into the ignored feel nourishing. Commercials, fast Growing up, I felt that I needed to feelings you might have been food, diets, contradictory information firmly keep myself together lest experiencing throughout a day just by can overwhelm us. I do not live in someone try and get inside my noticing what you are eating at a your body. I do not know what you emotional fortress that I thought was meal and how you are eating it. Food need but you do, and I love and feel protecting me. Yet, in doing so I was and our relationship with food are inspired by supporting others in trapped within myself and caused my metaphoric. Investigating our learning how to hear these messages body to stiffen and become armored. relationship with food can help us and trust them. Additionally, no My anxiety about being emotionally travel down the rabbit’s hole into a matter what place we choose to eat invaded shut down my ability to slew of information about how our from (our head telling us to eat sugar digest (physically and emotionally). relationship with food is indicative to or our gut telling us to eat some It felt contradictory at times that the how we relate to everything else in vegetables), there is no “wrong” way way out of my digestive issues was to life. to eat. Sugar cravings can be a sign of go into my body, to go into my protein or mineral deficiencies or a digestive tract, and begin to listen. As a teenager, I was a fast eater. I sense that sweetness is lacking in did everything else in life quickly, one’s life. But, no matter if you At first, I had no idea what I was too. I had a hard time feeling fulfilled decide to eat that piece of chocolate listening for from my guts. I had no by life and a difficult time feeling cake or cook yourself a piece of idea what hunger or satiation felt like satisfied by food. I had to get to the chicken and some vegetables, either to my unique body; I ate by what point of exhaustion and tears to slow way, it will be useful information and time it was. If I felt emotional down. This continued into my a way to tap into your internal state. emptiness, I figured I was hungry undergraduate years. My gut had because I had no idea there was a been waiting long enough to be I have learned that it is not just what difference between physical and heard. I did not feed it what it I eat, but how I eat that contributes to emotional hunger. I now define wanted both physically and a satisfying eating experience. If I eat physical hunger as my body’s emotionally. Emotionally my gut a “healthy” salad every day for lunch,

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Photo donated by Rebecca Fairchild at The Food Advice Centre www.Thefoodadvicecentre.co.uk

but I do not enjoy it, my guts will Here is an experiment you can giving yourself love on some cramp, digestion will shut down, and begin today: sit down with your meal conscious or unconscious level. I will not absorb all the nutrients without any distractions (no book, no from this supposed “healthy” salad. phone, no computer, no talking, no Have you ever been on vacation and television) and delve into the Be sure to read Stephanie’s related decided to eat whatever you wanted experience of eating. Smell your food article, The Enteric Nervous System in a relaxed manner and you actually before you take a bite. Notice your and Body Psychotherapy: lost weight? This has happened to me mouth salivate. Chew your first bite, Cultivating a Relationship in the Gut countless times, and I am always in notice the sensations happening in Brain in the International Body awe of how feeling relaxed in our your body and the thoughts as well. Psychotherapy Journal, Volume 13, viscera and eating with pleasure and Does a voice say hurry up and finish Number 1, Spring 2014 enjoyment can help our body to do this meal as fast as possible? What is what it naturally does and allow us to happening within and around you in Open access: http://www.ibpj.org/ feel healthy and vibrant in our body. this moment? What is your external environment like while eating this Stephanie Pollock MA, CHC, EPC, Lastly, I want to add that there is meal? Notice how the texture and the CYT is a Certified Nutritional no such thing as perfect digestion. taste change with every bite. Pause Counselor, Eating Psychologist, Certified When I feel uncomfortable in my gut, between each bite. Set your fork or Yoga Teacher, and has her Masters I have learned that I need to slow spoon down and notice what is degree in Body Psychotherapy. She encourages every individual to be an down and listen. Every ailment happening in your body? Does your active participant in their own healing; experienced in the body is the body’s gut want more? Is your head saying and to find nourishment that will work way of communicating. Within every eat more when your gut has had for you and only you. Stephanie stresses digestive complaint is a message enough? When you reach the point of bio-individuality and works with her waiting to be heard. Perhaps I am feeling full, observe what that feels clients to foster intuitive eating. You can eating too fast, or eating things I like in your body. Do you sense any e-mail her at [email protected]. know don’t sit well in my body, or I tingles, warmth, calm, clarity? am trying to fill an emotional hunger Additionally, take a moment to notice References with food. No matter what place I am what it feels like to give yourself Gershon, G.D. (1998). The Second Brain. eating from, I can view my digestive nourishment. Every time you eat you New York: Harper Collins, Publishers. Mayer, E. (2011). Gut feelings: the upset as information and not judge are engaging in the same act that emerging biology of gut-brain myself for doing something “wrong.” your parents did when you were born. communication. Nature Reviews, 12, Our experience with food is a Every time you eat you are 453-466. practice of compassion and self love. committing to be here on earth, to keep yourself alive, and you are

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Nine Steps to Calm the Anxious Mind Using Food and Nutrients

By Trudy Scott

Many biochemical factors can contribute to anxiety and since we all have our own unique biochemistry it’s a matter of figuring out each person’s root cause/s. I use a comprehensive 9- step approach with my clients to help them overcome their anxiety, depression, emotional eating, and sugar cravings. It is, of course, customized to their unique biochemistry, and includes:

 Why and how to eat real whole traditional foods

 Why and how to quit sugar and how to control blood sugar swings

 Assessing for the bad-mood effects of caffeine

 Optimizing digestion if necessary

 Assessing for bad-mood effects of gluten and other food intolerances

 Balancing brain chemistry with individual amino acids (to end anxiety and panic attacks, improve mood, and stop sugar and carbohydrate carvings)

 Correcting correct social anxiety / pyroluria with zinc and vitamin B6

 Addressing other nutrients (such as low vitamin D) and hormones imbalances

 Education about simple lifestyle changes that include sleep, exercise, and yoga

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Real Whole Traditional Foods are Associated with a Lower Risk of with a lower risk of mental health included plenty of produce and also Anxiety (and other mood issues. They found that included lean red meat, which “was disorders) “improvements in diet quality were associated with a decrease in mirrored by improvements in mental depression.” It should be noted that There is a growing body of health over the follow-up period, the meat was grass-fed red meat. evidence supporting the very while deteriorating diet quality was powerful connection between food associated with poorer psychological With regard to red meat, the best and mental health disorders such as functioning.” The author stated that quality is grass-fed, and the anxiety and depression. An editorial this “study highlights the importance Australian study mentioned at the in the American Journal of Psychiatry of diet in adolescence and its beginning of this article (Jacka, offered a powerful comment: “It is potential role in modifying mental Pasco, Mykletun, Williams, Hodge et both compelling and daunting to health over the life course.” al., 2010) found that including grass- consider that dietary intervention at Another study (Jacka, Mykletun, fed red meat in the diet had mental an individual or population level Berk et al., 2011) looked at health benefits. In fact, in an could reduce rates of psychiatric Norwegian adult men and women and interview in January 2010, the lead disorders. There are exciting found that “those with better quality researcher in that study, Dr. Jacka, implications for clinical care, public diets were less likely to be depressed” stated, “We’ve traditionally thought health, and research” (Freeman 2010, and that a “higher intake of processed of omega-3s as only coming from 245). and unhealthy foods was associated fatty fish, but actually good-quality with increased anxiety.” red meat, that is naturally raised Dr. Felice Jacka is an Australian (meaning grass-fed) has very good researcher who is one of the leaders Canadian adults with mood levels of omega-3 fatty acids, in the field of food and mental health. disorders had the following whereas red meat that comes from Her co-authored study published in measured: intake of carbohydrates, feedlots tends to be higher in omega- the The American Journal of fiber, total fat, linoleic acid, 6 fatty acids—a fatty acid profile that Psychiatry looked at both anxiety and riboflavin, niacin, folate, vitamin B6, is far less healthy and may in fact be depression among women and found B12, pantothenic acid, calcium, associated with more mental health a link between better diet quality and phosphorus, potassium, iron, problems” (Cassels, 2010). Via email better mental health (Jacka, Pasco, magnesium, and zinc. The authors correspondence, Dr. Jacka informed Mykletun, Williams, Hodge et al., found that “higher levels of nutrients me that “consumption of beef and 2010). Among the participants, those equated to better mental lamb was inversely associated with who ate a whole foods diet of health” (Davison & Kaplan, 2012). depression . . . Those eating less of vegetables, fruit, fish, whole grains, this form of red meat were more and grass-fed lean red meat and lamb One of the study authors, Dr. likely to be depressed” and anxious. had a lower likelihood of both Kaplan, was quoted as saying: anxiety and depression. The “Doctors should consider counseling When the mainstream media starts researchers referred to this as a their patients to eat unprocessed, to publish articles like “Can What “traditional” diet. Those who ate a natural, healthy foods and refer them You Eat Affect Your Mental typical Western diet, replete with to a nutrition professional if health?” (Washington Post, 2014) we processed, refined, fried, and sugary specialized dietary consultation is know that people are starting to foods, and beer were more likely to needed.” I am definitely in favor of notice the research and the effects of experience depression. this and would love to see all doctors food on our mood. and mental health professionals A follow-up study (Jacka, Pasco, working as a team with nutrition The Harmful Effects of Sugar and Mykletun, Williams, Nicholson et al., professionals. Preventing Blood Sugar Swings 2010), paralleling the previous Australian study on diet, depression, In another Australian study Eating refined sugar and other and anxiety, found women who ate a (Torres & Nowson, 2012), it was refined, processed carbohydrates, and quality, whole foods diet were less found that in “addition to the health resulting excessive fluctuations in likely to have bipolar disorder. benefits of a moderate-sodium blood sugar levels can contribute to Dietary Approaches to Stop anxiety. Addressing these factors Dr. Jacka is also the lead author in Hypertension diet on blood pressure often reduces and sometimes a PLoS One paper (Jacka, Kremer, and bone health, this diet had a completely alleviates anxiety, Berk et al., 2011) that found that diet positive effect on improving mood in nervousness, irritability, and feeling quality in adolescents was associated postmenopausal women.” This diet stressed and overwhelmed.

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Curious about Food, Mood, and Your Health?

Check out: 9 Great Questions Women Ask About Food, Mood & Their Health

www.everywomanover29.com

Sugar (and alcohol) may intestinal bacterial overgrowth, and (Hallert et al., 2009). contribute to elevated levels of ulcerative colitis frequently suffer lactate in the blood, which can cause from anxiety and, to a lesser extent, In a 2012 paper in Psychiatric anxiety and panic attacks. Anxiety depression (Addolorato et al., 2008). Quarterly (Jackson, Eaton et al., sufferers may be more sensitive to 2012) the authors state that: “gluten lactate (Maddock, Carter, & Gietzen, Addressing food allergies/ sensitivity remains undertreated and 1991). intolerances, adding enzymes, eating under recognized as a contributing unprocessed foods and more raw factor to psychiatric and neurologic Refined sugars and sweeteners are foods, eating fermented foods like manifestations.” harmful because they contain no sauerkraut, and adding probiotic nutrients beyond carbohydrates for supplements can all help. Cooking at Individual amino acids balance energy. During refining and home, eating sitting down, and brain chemistry processing, minerals such as chewing the food slowly also makes chromium, manganese, zinc, and a difference. The targeted use of individual magnesium are stripped away. Your amino acid supplements can balance body, therefore, has to use its own The Bad-Mood Effects of Gluten brain chemistry to alleviate anxiety, reserves of these minerals, as well as fear, worry, panic attacks, and feeling B vitamins and calcium, to digest the I’ve seen so many clients stressed or overwhelmed. sugar, resulting in depletion of all of experience dramatic mood Supplementing with specific amino these nutrients, many of which are improvements when they avoid acids can also be helpful in important for preventing anxiety and gluten, so I always recommend that addressing other problems that depression. my clients with anxiety and other contribute to or exacerbate anxiety, mood problems go gluten free. Doing such as sugar cravings and The Bad-Mood Effects of Caffeine so may completely resolve symptoms addictions. In addition, supplemental of anxiety, especially among people amino acids can help with depression Chronic, heavy use of caffeine can who aren’t benefiting from and insomnia, which often co-occur cause or heighten anxiety and may antianxiety medications (Potocki & with anxiety. lead to increased use of antianxiety Hozyasz, 2002). Clinical experience medications (Clementz & Dailey, and specific studies support the The brain chemicals or 1988). Like sugar, caffeine can lead connection between gluten and neurotransmitters that play a major to higher levels of lactate in your anxiety (Hallert et al., 2009; role in anxiety are GABA (gamma- blood and make you more prone to Pynnönen et al., 2004), social phobia aminobutyric acid) and serotonin. anxiety and panic attacks. Also, (Addolorato et al., 2008), depression people with panic disorder and social (Pynnönen et al., 2005), and even Low levels of GABA are associated anxiety may be more sensitive to the schizophrenia (Kalaydjian et al., with anxiety, agitation, stress, and anxiety-causing effects of caffeine 2006). poor sleep (Lydiard, 2003). If people (Lara, 2010). have sufficient GABA, they will feel Gluten sensitivity can limit the relaxed and stress free. They won’t The Importance of Optimal availability of tryptophan and have anxiety or panic attacks, and Digestion therefore lead to decreases in levels they won’t eat sugary foods (or other of serotonin (Pynnönen et al., 2005). starchy foods) in an effort to calm Studies have found that people Another possible mechanism is down. Although there is much with digestive complaints such indirect effects of gastrointestinal clinical evidence that taking Irritable Bowel Syndrome, food damage due to eating problem foods, supplemental GABA orally can help allergies and sensitivities, small resulting in nutrient malabsorption with anxiety, there are theories,

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supported by a few studies, that social anxiety. An hour after eating enhancer that modulates the way one GABA taken orally doesn’t cross the this functional food, subjects were thinks and perceives the physical and blood-brain barrier and enter into the less anxious when asked to speak in social world.” brain in amounts substantial enough front of others. to have a calming effect. However, I have seen such dramatic results with Social Anxiety / Pyroluria can be Food Mood Expert Trudy Scott is a GABA, and with so many clients, that addressed with Zinc and Vitamin certified nutritionist on a mission to I am a firm believer in oral GABA. B6 educate and empower women worldwide about the healing powers The neurotransmitter serotonin is Low levels of the mineral zinc and of food in order to find natural the brain’s natural “happy, feel-good” vitamin B6 are frequently associated solutions for their anxiety, chemical. If people have sufficient with a type of anxiety characterized depression, emotional eating and serotonin, they’ll feel calm, by social anxiety, avoidance of sugar cravings. Trudy works with easygoing, relaxed, positive, crowds, a feeling of inner tension, clients one-on-one and in groups, confident, and flexible. They won’t and bouts of depression. People with serving as a catalyst in bringing about have afternoon and evening carb this problem experience varying life enhancing mood transformations cravings, and they will sleep well. degrees of anxiety or fear, often that start with eating real whole food While most research on serotonin and starting in childhood, but they usually and using some pretty amazing its precursors, tryptophan and 5-HTP manage to cover it up. They tend to nutrients. Trudy is author of The (5-hydroxytryptophan), has focused build their life around one person, Antianxiety Food Solution: How the on depression, there is evidence that become more of a loner over time, Foods You Eat Can Help You Calm low serotonin is involved in anxiety have difficulty handling stress or Your Anxious Mind, Improve Your disorders (Birdsall, 1998). Serotonin change, and have heightened anxiety Mood & End Cravings (New levels also affect sleep, anger, PMS, symptoms when under more stress. Harbinger, 2011). Trudy publishes an carbohydrate cravings, addictive electronic newsletter entitled Food, behaviors, and tolerance of heat and This constellation of symptoms is Mood and Gal Stuff, available at pain (Birsdall, 1998). often the result of a genetic condition www.everywomanover29.com and called pyroluria, also known as high www.antianxietyfoodsolution.com Supplements of 5-HTP, the mauve, pyrrole disorder, pyrroluria, intermediate between tryptophan and pyrolleuria, malvaria, and elevated serotonin, increases serotonin levels kryptopyrroles. Supplementing with References and is effective for relieving anxiety zinc and vitamin B improves the 6 Addolorato, G., Mirijello, A., D’Angelo, (Birdsall, 1998). In particular, it can many signs and symptoms of C., Leggio, L., Ferrulli, A., Abenavoli, L. be helpful with panic attacks and pyroluria (McGinnis et al., 2008a; et al. (2008). State and trait anxiety and generalized anxiety (Lake, 2007), and 2008b; Mathews-Larson, 2001). depression in patients affected by agoraphobia (Kahn et al., 1987). It is gastrointestinal diseases: Psychometric also effective for depression, binge In Conclusion evaluation of 1641 patients referred to an eating, carbohydrate cravings, internal medicine outpatient setting. headaches, sleep problems, and The effects of other nutrients (such International Journal of Clinical Practice fibromyalgia (Birsdall, 1998). as low vitamin D) and hormone 62(7):1063-1069. imbalances must also be considered. Tryptophan, which first converts to Simple lifestyle changes that include Birdsall, T. C. (1998). 5- Hydroxytryptophan: A clinically- 5-HTP and then to serotonin, has sleep, exercise and yoga can have a effective serotonin precursor. Alternative benefits similar to those of 5-HTP great impact. Medicine Review 3(4):271-280. (Lehnert & Wurtman, 1993; Ross, 2004). In one study (Zang, 1991), 58 A 2013 study that looked at the Cassels, C. (2010). Whole diet may ward percent of patients with generalized effects of tryptophan supplementation off depression and anxiety. Medscape anxiety who took 3 grams of and tryptophan-containing diets on Medical News. www.medscape.com/ tryptophan daily experienced fostering interpersonal trust (Colzato, viewarticle/715239. significantly less anxiety. A more 2013) sums it up beautifully: the recent study (Hudson, Hudson, & “results support the materialist Clementz, G. L., & Dailey, J. W. (1988). MacKenzie, 2007) suggests that a approach that ‘you are what you Psychotropic effects of caffeine. American Family Physician 37(5):167- functional food rich in tryptophan, eat’—the idea that the food one eats 172. made primarily of pumpkin seeds, has a bearing on one’s state of mind. could be an effective treatment for Food may thus act as a cognitive Continued on page 111

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The anti-anxiety food solution

Written by Trudy Scott

Reviewed by Phillipe Kleefield

If you are living in a developed country, especially one job of addressing what can and cannot be eaten, making like the United States, thoughts about food, appearance, specific (as opposed to general) references to foods, and the body can be daily worries that consume high ultimately leading to a concrete picture of what the diets amounts of much needed energy. Despite this reality, will consist of. Although it is recommended to take two Trudy Scott, CN, has written a refreshing guide linking weeks to eat a diet with the highest level of restrictions, food with both mood and health, avoiding reference to the four different diets, while all healthy, do range in their concerns about appearance or the body, arguing that for respective restrictions, allowing the reader some choice in people suffering from anxiety, mood issues, or physical choosing which diet they will subscribe to. Following issues (e.g., digestive disorders), changing what you eat these diets, according to Scott, should lead to a relief of may just be enough to alleviate these issues. In The Anti- negative physical and mental health symptoms. Anxiety Food Solution, Scott presents a comprehensive solution for people experiencing negative mental and In addition to making dietary changes, Scott is quite strict physical health symptoms, drawing on dietary changes, about sugar, caffeine, alcohol, and nicotine. In the second brain chemistry information, lifestyle changes, chapter, sugar is linked to issues maintaining healthy supplement information, and other information to blood sugar levels, which is then linked to anxiety and effectively target and eliminate unwanted symptoms. mood issues, the recommendation being that sugar should be avoided, especially artificial sweeteners. In the third Scott doesn’t just tell you about what your diet should chapter, coffee, alcohol, and nicotine are also explored in consist of, she is good about demonstrating this through reference to anxiety and mood, with the recommendation charts and tables, and her first chapter is the critical being that these different substances should be avoided. chapter that will allow you to figure out what might be As these recommendations might be too restrictive for wrong and how to go about fixing this. In “Figure Out people, Scott does stress using moderation if complete Your Optimum AntiAnxiety Diet”, Scott discusses four avoidance cannot be obtained. diets which she approves of, and she recommends that everyone start for two weeks with a combination of all The subsequent chapters discuss a range of topics from the restrictions she mentions and to slowly start adding food sensitivities to amino acids. In the fourth chapter, these restricted foods as a means of knowing whether you the book stresses the importance of eliminating any foods have a particular food sensitivity, such as gluten, dairy, that one might be sensitive to and offers a controlled way grainy starches, grainy vegetables, grainy legumes. In by which to assess this. The fourth chapter walks through discussing the four different diets, she does a thorough a more detailed list of the sensitivities mentioned in the

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earlier chapters, explaining the (small amino acids that are symptoms that might be associated derivatives of tyrosine), and with a sensitivity and explaining how endorphins (inhibitory they might impact anxiety and mood. neurotransmitters), and overall, is Trudy Scott explores This chapter is more focused on specific about how to introduce these explaining the sensitivities whereas amino acids into a diet. how various amino the earlier chapters were more focused on general diets that should Chapters seven and eight discuss a be adopted. The fifth chapter condition called Pyroluria, as well as acid supplements examines digestion, how digestion zinc, vitamin B6, hormone functions, how it can be improved imbalances, medications, other have been linked overall through changing eating nutrients, and lifestyle changes. habits, correcting for low stomach Pyroluria is a condition that involves acids or pancreatic enzymes, eating a faulty synthesis of heme that results to common fiber and drinking water, and in elevated levels of kryptopyrroles balancing bacterial parasites or and HPL, which bind to zinc and neurotransmitters candida overgrowth. The sixth vitamin B6 to eliminate them from chapter is what is the most unique the body in great amounts. This and interesting about this book as it resulting nutritional deficiency can that are integral in explores a link between brain result in several issues and can be chemistry and amino acids, counterbalanced through zinc regulating digestion, suggesting that amino acid supplements, vitamin B6 supplementation can alter brain supplements, and through taking chemistry to improve mood, anxiety, certain fatty acids. Chapter eight anxiety, and mood, and digestion. Addressing a means by explores other basic vitamins and which to supplement one of the diets supplements like: B vitamins, iron, and how particular delineated in the second chapter, or vitamin C, magnesium, calcium, realistically, for those who may not vitamin D, omega 3’s and Omega 6’s, amino acid stay faithful to any of the diets, Scott theanine and lactium. Hormonal explores how various amino acid imbalances are also addressed, such supplements have been linked to as adrenal dysfunction, thyroid supplements might common neurotransmitters that are dysfunction, and sex hormone integral in regulating digestion, imbalances. There is an overview of be used to treat anxiety, and mood, and how different toxins to avoid are provided, particular amino acid supplements and an overview of how to pay might be used to treat these issues. attention to side effects when taking these issues. particular medications, and an One of the several amino acids overview of different lifestyle explored is GABA, both a modifications and changes that need neurotransmitter and an amino acid. to be made in order to feel your best GABA’s role in the body has been and minimize mental and physical linked with regulating anxiety, health issues. agitation, stress, and sleep. The idea Phillipe Kleefield is currently a student is that if you have enough GABA, The AntiAnxiety Food Solution is a at New York University where he is you will feel relaxed and rested and comprehensive guide that helps in pursuing his Masters of Arts degree in thus will not have cravings to eat dealing with anxiety, mood issues General Psychology. He is interested in clinical psychology and would like to certain unhealthy foods. Specifically, and negative physical symptoms pursue either a PhD or a PsyD degree. He someone may have low levels of using an alternative to traditional enjoys reading, especially books that are GABA because not enough is able to medication. Written for anyone psychologically oriented. Before cross the blood brain barrier. GABA suffering with moderate to severe attending this program, he worked in the supplements are introduced and negative symptoms, Trudy Scott’s field of social services as a Case discussed as a means of regulating book is a handy and thorough Manager. Phillipe graduated from Vassar possible low levels. The chapter does antidote. College in May of 2009 where this as well for serotonin (a academically he studied sociology and neurotransmitter), catecholamines neuroscience, and was active in LGBTQ student events and programming.

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Exploring Binge Eating Disorder Through the Body

By Debbie Cotton MA, BHSc, ND

“I am simultaneously having a relationship with two men at the same time, the first is named Ben, and the second Jerry.” Bridget Jones Diary, by Helen Fielding

I spend a good part of my life talking about food, cooking food, eating food, researching food behaviour, and teaching people about food. The more I engage with it, the more of an enigma it becomes to me. As humans, our relationship with food is one of intense complexity. Food is a physical need we all have for survival – so much so we have complex homeostatic mechanisms that hi-jack our thinking processes to make finding it a top priority. Aside from the physical need, food can also act as a conduit for expression of our personal, social, spiritual, and emotional selves. Food is an object that we have a relationship with; through it, we can express a wide array of ourselves, sometimes consciously but more often than not sub-consciously. These expressions of self are clearly brought to the fore in therapy with people suffering with eating disorders.

In the latest edition of the control over the binge” (APA, 2013, is a complex expression of one’s self- Diagnostic and Statistical Manual of p.350). Patients with BED do not regulation capacities and may contain Mental Disorders (DSM-5), Binge undertake purging techniques as in a multitude of psychological Eating Disorder (BED) has emerged bulimia nervosa, but the binge is meanings. In my work I have as a new diagnosis in its own right, followed with marked distress. explored many different theories of taken away from the Eating Overweight and obesity is a common binge eating in a framework of Disorders not Otherwise Specified side effect of BED, but it can also relational body psychotherapy. category (EDNOS) diagnosis within occur in normative weight patients. the Feeding and Eating Disorders The triggers for binge eating are I will explore these theories of section (American Pyschiatric often shown to be interpersonal binge eating and how they can be Association, 2013). BED is difficulties and negative affect useful when working in a relational characterised by recurrent episodes of (American Pyschiatric Association, body psychotherapy approach with binge eating in which the person 2013). Even though BED is a new clients experiencing binging. Due to consumes in a short period of time diagnostic category, it is a process the fact that I work relationally, I also “an amount of food that is definitely that can often appear in clients as a hold in mind that as therapists we, larger than what most people would coping technique during a course of too, need to examine our own eat under the same circumstances” therapy, regardless of diagnosis. The relationship with food and our coupled with a “lack of sense of presence of binging in a person’s life bodies; the nature of the inter-

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The major differentiating factor of unhealthy versus healthy relationships with food in the DSM-5 is the marked emotional distress that the binging behaviour causes. I often see a flavour of feelings of self-harm, shame, and negative self-talk that occur concomitantly with the binging and that it is used to regulate emotional states or as a form of trance induction for dissociating (Fuller-Tyszkiewicz & Mussap, 2008). I personally believe that becoming more mindful of our relationship with food, even if we subjective relationship between client to reduce the ‘obesity crisis’, with a consider our relationship with it to be and therapist and between food and media culture that prizes skinny and ‘normal’, can be a helpful and body issues will permeate into the somewhat unattainable figures due to illuminating process for all of us. relational space like the preverbal wonders of photoshop, with a culture elephants that sit in the room with us. that engages with ‘fat shaming’, and Binging as Self-Medication As they say, “healer, heal thyself.” a marketing explosion of countless diet books and consumers are often A good place to start with What is Binging and Where Does left completely bewildered around understanding binging is with the physiology of the process. It Come From? how to eat in healthy ways. To make matters worse, our brains are Macromolecules and phytochemicals To deter from the norm, first we must designed to seek high-calorie, sweet in food can have a strong try to define a normal diet and eating foods, and in developed countries we physiological impact on our nervous behaviour, which is a near impossible are now surrounded by an system lending food addictive task! A normal diet is intricately environment that makes access to qualities. Consumption of any type of intertwined with our culture and these foods all too commonplace food triggers dopamine release in the reward centre of the brain. This is an environment; what is normal for an (Zheng & Berthoud, 2007). evolutionary mechanism that enables American is completely alien to another culture such as the us to experience the consumption of Okinawans. To make matters more In this sea of confusion we are left food as a good experience, which complex, one just has to pick up any with the question, nutrition research journal and within how do we define minutes will be inundated with what is a healthy contradictions and controversies relationship and what about what a normal, healthy diet is. is an unhealthy Contradictory messages are relationship with everywhere: fat will make you fat, oh food? Many no, new research says eating more fat researchers are now is better for you; eating more protein saying that binging is makes you slim, but eating more a normal reaction to protein reduces your life expectancy; an abnormal food- margarine is better for you, whoops, laden environment; we’ve just realised it’s full of trans- our brains and genes fats that increases the risk of heart are wired this way so disease; fish makes you smarter, but it is important that we it’s full of mercury that will damage do not end up your brain. Utterly confusing isn’t it? pathologising Couple these contradictory research everyone. findings with government incentives

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find that particular food again and do. Therefore, the foods of choice for again so that we can consume enough binging are often refined sugary calories to stay alive. Have you ever foods sometimes coupled with fat wondered why every time you turn and salt that increase the feel good onto the street where your favourite neurotransmitter release. I have had coffee shop is you begin to think clients who have tried to binge on Food and about the amazing brownie they salads and have reported that it just make before you even remember the wasn’t satisfying or didn’t help as shop is nearby? You can thank much for emotional regulation. nourishment dopamine and your brain for remembering the previous good In this physiological capacity, experience before you have even binging becomes a self-medicating is intimately noticed where you are. action against low mood and overwhelming feelings. It becomes a Some types of foods give more of a useful, albeit destructive, tool for wrapped up dopamine release then others. someone who has no other tools to Carbohydrate laden foods that release self-regulate emotional distress, low high amounts of simple sugars such mood, or anxiety. Co-morbidity with our as sucrose enable us to release higher studies have shown that people with amounts of dopamine than other food BED often have other psychiatric stuffs. Unfortunately, we can’t trick diagnoses such as anxiety, earliest this pathway with other things that depression, substance use disorders, taste sweet, it’s only sucrose or and post-traumatic stress disorder glucose with the calories they contain (PTSD) (Grilo, White, Barnes, & relational that do this job; hence, artificial Masheb, 2012, 2013). sweeteners don’t hit the same ‘oh that tastes good’ spot. One thing that From a clinical point of view this experiences is remarkable about sugar gives us quite important information consumption is that in opposition to to conceptualise our client’s process other food stuffs, the more we of binge eating behaviour. Being with our care consume sugar, the more sustained aware that it is a physiological self- the dopamine release in the brain is. regulation technique means that Combine it with salt and fat and we firstly, we must help our clients to givers. Food get an even more pronounced impact. identify what they are medicating The activation of these dopamine against, whether it is negative affect pathways sets up an addictive quality or another condition such as is never to these food types as it uses the depression or trauma. Secondly, I same reward system (to a lesser personally find that a good dose of amount) as serious drugs of addiction psycho-education around these delivered to (Davis, 2013). Coupled with processes helps to reduce some of the dopamine release, glucose helps to shame that surrounds the behaviour, facilitate the amino acid tryptophan opening a window of opportunity to babies in a across the blood brain barrier. start engaging and looking at it in a Tryptophan is the pre-cursor to more gentle way. I find if clients serotonin, so more in the brain helps understand it is a valid way of raising way that is to stabilise a depressive mood. This their neurotransmitters, it gives them mood lift is only short lived; the hope that there may be other ways of neurotransmitters quickly fade and learning how to self-regulate and that devoid of the blood glucose will drop making looking at the story underneath may us look for another hit of sweet, bring real hope for change. I also sugary goodness. Reaching for that find that understanding these relationship. second piece of cake is wrapped up physiological processes puts it into in your neurotransmitters and glucose perspective—it is not because levels telling you it is a good thing to someone has ‘poor willpower’ that he can’t stop his binging cycles.

Permission was granted to share client stories.

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Food as an Expression of Our 2014). If we extrapolate this into fact, these occurrences generally are Early Attachment Relationships clinical practice it gives a few the best opportunities for important points that can be illumination and healing to happen if Food and nourishment are incorporated into the they are caught and discussed. I intimately wrapped up with our psychotherapeutic relationship. The often take a long holiday, and earliest relational experiences with role of the therapist, no matter what periodically I go to another country our care givers. Food is never orientation, in the beginning stages of where contact is very limited with delivered to babies in a way that is therapy with a BED client, should my clients. In many cases, these devoid of relationship. Mamma (or focus on containment, creating safe prolonged breaks are both a trigger other primary caregivers) is boundaries, and fostering a secure for my BED clients, as well as a synonymous with food and also with attachment for the work to occur helpful catalyst for change when I love, comfort, warmth, safety, and within. A strong-yet-nurturing return as it becomes a here-and-now meeting of other needs. If early container will eventually allow for relational opportunity to work beginnings were not so safe, food the attachment anxiety to be through issues of abandonment, may become associated with terror, expressed within the therapeutic misattunement, and attachment overwhelming feelings, and dyad. This can then be challenged anxiety. confusion of trying to regulate the and worked with. In my experience, mother’s feelings in hopes of clients with BED often have a high connection. Both psychoanalytic and need for a strong-yet-nurturing Dissociation, Body Awareness, and object relations theory have complex relationship that meets their oral Binge-Eating theories to examine eating needs before they are willing to behaviours and these early patterns. I really challenge their eating prefer attachment theory as a way of behaviours. There is a shadow side of Dissociation occurs within the binge understanding the impact of these this relational approach though. cycle (McShane & Zirke, 2008). formative years on later adult Breaks in the therapeutic relationship There are a few theories around behaviour. Attachment theory states with the therapist may also become a supporting this finding. The first that babies will seek and try to trigger for binge eating episodes. maintain a close proximity to theory is that binging provides a care-givers and that their psychological defense mechanism to experience of this bring about dissociation to escape relationship will become from the awareness of threatening internalised as an internal stimuli and emotions. The second working model, which they theory is that binging occurs because apply to other significant the person already possesses relationships in later life dissociative tendencies, culminating (Wallin, 2007). The not-so- in a skewed awareness of self-image nice experiments by Harry and body sensations so that he is Harlow on rhesus monkeys more likely to exhibit lack of self- showed how comfort, control and awareness around food attachment, and security intake (Fuller-Tyszkiewicz & were more important than Mussap, 2008). In a study that milk alone with baby looked at the personality traits of monkeys choosing a nice, persons experiencing binging, the warm, soft mother rather results found that many BED than a cold one that only sufferers in the cohort possessed an provided food (Harlow, inadequate ability to recognise 1958). From this we can begin to emotional states and body sensations This may occur if the therapist coupled with excessive feelings of understand that food is not our becomes ill, or has to cancel primary drive—comfort and safety inadequacy, worthlessness, and appointments, or go on holiday. It insecurity due to their body size are. may also manifest if clients feel (Izydorczyk, 2013). ‘missed’ by the therapist, they may Clinical research has shown that increase binging behaviour instead of The thing I find most interesting in patients diagnosed with bulimia expressing their negative affect nervosa have been found to have a these theories and findings is the directly. This doesn’t mean these concept of the lack of awareness of higher incidence of insecure occurrences need to be avoided; in attachment styles (Tetzlaff & Hilbert, body sensations and the resultant

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dissociation. It is in this arena that I therapist to engage in precise first met her was of little girl trapped believe body psychotherapy is an dialogue around: safety, felt-sense, within a large women’s body. I invaluable tool for helping clients skin boundaries, and feelings of always had the pull with Wanda to with BED to become more robust invasion or disgust, as well as want to ‘feed her’ either with words and comfortable with their body feelings of pleasure in the body. If I or with gentleness, often to the point image, feelings, and sensations. This do use touch with BED clients, I where I felt almost ashamed for it, so can be achieved by paying attention make sure I come from a place of I decided with my supervisor to take to one’s bodily self and helping to ‘being-with’ my client and enable a slow and gentle approach. introduce techniques to increase them to lead the interactions instead tolerance around one’s body of an expert stance of ‘doing-to’. I In our first stage of therapy sensations. These techniques can find if touch interactions are framed Wanda and I concentrated on vary dependant on the training of the as an experiment, with safety creating a safe and secure therapist and the needs of the client discussed explicitly in the here-and- relationship. Her attachment but they may include: now, it can become a beautiful insecurity was high. She protected conduit for expanding the client’s herself from this fear by never window of tolerance to his body missing a session, coming -the use of trauma –based techniques sensations. consistently early, and doing that utilise body scanning and body everything to be a ‘good girl’ to sensing such as the work of Peter Putting it All Together: please me. Once she trusted enough Levine, Babette Rothschild, Pat A Case Vignette that I would be present every week Ogden, or similar (Levine, 2010; for her, we started to unpack her Ogden, Minton, & Pain, 2006; Wanda is a 43-year-old woman who anxiety around the attachment with Rothschild, 2009) came to me for feelings of depression her mother and all of the negative that she had been medicated for. Her affect such as sadness, anger, and - the use of movement techniques relationship with her mother was hate that she buried to make sure she within the therapy, such as the work tricky. Her mum had always needed maintained that necessary of dance movement therapy, most of the emotional care and relationship. The more we unpacked authentic movement or similar attention, which resulted in her father the relationship with her mother and (Pallaro, 1999) suppressing Wanda’s feelings as to father, Wanda gradually became able not destabilise her mother. She to tolerate her negative affect. I soon -the use of mindfulness based became extremely good at went on a short holiday, and Wanda techniques for eating awareness chronically caring for others, was able for the first time to become (Kristeller, Wolever, & Sheets, 2013; including her husband, children, and angry with me for not being around Smith, Shelley, Leahigh, & Vanleit, friends, often to the detriment of for her when a drama had happened 2008) herself. Wanda was extremely obese in her life. After her new experience and this impacted her health quite of seeing that she could be angry - the use of physical touch or severely. During our initial with me and that our relationship did massage (Field et al., 1998) consultation, she mentioned that she not crumble, and that I didn’t sometimes binged on sugary foods overwhelm her with upset, she The use of these body orientated and alcohol, but most of the time she became even more able to tolerate techniques may arise the question, engaged with a weight-watchers her feelings of anger and sadness. should we touch clients with BED, program to try and (unsuccessfully) especially in light of the possibility control her weight. Wanda described Not long after this incident, Wanda of trauma being correlated with the her depression mainly as a wish to decided with her GP to trial coming disorder? My answer to that would feel numb, and she loved taking the off her anti-depressant medication. In be dependent on each case and each anti-depressant medication as it made this stage of our therapy, she became client. Personally, I find touch an her fingers feel numb after she took much more open about how she felt empowering way for client and it. My experience of Wanda when I about her weight and her eating

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patterns. With the medication gone, decreased until they almost disappeared. She has also lost over she no longer felt physically or disappeared, and it was at this point 100 pounds in the process. emotionally numb; she began to we entered another stage of therapy. notice more of her binges and how Wanda no longer using binging as a they were a tool to help her to numb Through her mindfulness around self-regulation tool. She is much herself. It was at this point that we eating and her explorations of more able to tolerate strong discussed the physiology of binging, fatness, Wanda discovered even more and how it can be used as a tool of so how much hatred she had turned emotions, and her interpersonal self-medication. Concurrently ,I also inwards toward herself. Wanda began relationships with her family have gave into my feeding urges with to practice being more assertive in flourished. Wanda has now left Wanda, and I consciously acted it out her relationships, ours included. She therapy with me, but she feels much by giving her a self-help book called, also embarked on a journey of self- more confident that she can feed When Food is Love (Roth, 1991), care and re-building her internal herself in loving ways in the world. which details a person’s struggle mother. As our relationship had with binge eating. The combination become a secure base for her, she In Conclusion: of me extending myself to her and began to explore outside of therapy Feeling Your Next Mouthful of her own personal resonance with the other things that made her feel good Food woman’s story started Wanda on a such as movement, touch, drawing, new stage of discovery in which exercise, and cooking healthy food. In this consumerist world of fast binge-eating and her relationship Every time she felt the need to binge, food, I hope that even if you choose with food became her focus. Wanda she either drew upon the feelings of not to work with binge eating clients became mindful around when she security she had gotten from our in your practice that you at least take binged, what food she binged on, and sessions, or she employed one of her a moment the next time you put some what feelings may have triggered her. new self-care techniques. She food in your mouth to really taste, In therapy, we looked at the cognitive realised her mother was one of her feel, savour, and enjoy the complete aspect of the trigger leading to a biggest triggers for binge eating, so bodily experience that food can be binge to help her decipher what she became pro-active in taking care and that you use this sensual feelings she was trying to move away of herself around her. Around this experience of ways of making food from, and we also explored the stage of our therapy, Wanda was choices that are loving for you. As they say in Italy, ‘buon appetito’. physical quality of the binging: accepted for weight loss surgery.

What did it feel like in her body? This became the focus of our therapy sessions for the next few Debbie Cotton MA, BHSc, ND What was it like to engage with months. She wanted to make a Debbie works both as a relational body psychotherapist and a naturopath in certain textures, smells, and tastes? decision based on what was loving London, UK. In her capacity as a for her and her health and not be Wanda began to pay even more relational body psychotherapist, Debbie drawn in by the voice in her head that employs her knowledge of physiology, attention to food and to how it felt in equated skinniness with love. Once touch, movement, and the mind-body her body. She started to become she felt that she was at a point where connection into her work, taking a excited about food in more positive she was making the right choice, for holistic and relational stance with all of ways– not just her binges. I gently the right reasons, Wanda accepted her clients. As a naturopath Debbie has lead Wanda to become more body the surgery offer. But, she told the both a scientific and eclectic interest in aware at this stage. We explored her surgeons she was going to do it ‘her nutrition and herbs and how they impact sensations in her body, and what it way’ by making sure she ate things our mental and physical health. She was like for her to be fat. Being that were nourishing for her body, frequently lectures, writes training material, clinically supervises students overweight myself at the time, we and that she was not going to get were both able to explore her own both in nutritional and herbal medicine, caught in calorie counting diets or and organises CPD in relational body feelings around what it was to be fat, excessive weighing. Instead, she was psychotherapy. If she isn’t working, you and also her projections of how she going to continue her practice of will probably find her foraging or perceived me in my body and my being mindful of what her body cooking up some strange concoctions in fatness. This called me to be both needed. Wanda’s surgery went the kitchen to trial on an unsuspecting gentle and kind to my own body in remarkably smoothly. Six months out victim. Be careful if you come to her relation to her, so we entered an of it she feels healthier than she ever house for dinner, you never quite know intersubjective dance of exploring has in her life. Her risks of cardio- what manner of things you might be ‘fatness’ and practicing self- vascular disease and diabetes have served. kindness. Her binges slowly References on page 110

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Reclaiming Yourself from Binge Eating: A Step-By-Step Guide to Healing

An Interview with Leora Fulvio, MFT

By Nancy Eichhorn, PhD

"It started with bread."

That simple sentence begins an in-depth, complex look at binge eating disorder—its etiology and its treatment. Leora Fulvio, MFT offers an extensive mind-body-spirit guidebook that utilizes mindfulness and self-acceptance to help readers witness their own dysfunctional relationships with food and come to a healthier place of self-love and healing on every level.

Fulvio openly discusses her younger self, her foray Working with women experiencing “hard core eating into self-denial, her will to replace hunger with wine and disorders” (binge eating, bulimia, anorexia), Fulvio began diets, with exercise and starvation, with self-control and a blog in 2007. Her intention stemmed from her work discipline, all the while losing out to hunger and self- with clients and from her experience with online sites loathing. Obsessing about food and her body prevented supposedly offering help to women with binge eating her from living her life, she says. And from this place of disorder yet were in truth “preying on people” (e.g., the craving and self-sabotage, Fulvio realized that she was diet industry, liposuction, laser fat removal). Fulvio heard “losing the battle between a healthy mind and body and a women saying, "I’m sitting here completely alone, and horrible eating disorder—sick body and sick mind” (p. 3). I'm starting to binge, and I can’t stop, I feel totally powerless against food, and then after I binge, I just hate “I have been working with women and food and body myself, and I want to die. Can someone help me?” So she image issues since 1999,” Fulvio says. “I was a started an advice blog to let people know they were not hypnotherapist working with women dealing with alone, that there are others out there dealing with binge overeating issues, and I realized that it was more than a eating disorder. bad habit. I had my own eating issues, but I hadn’t gone into depth with my own recovery. It became a parallel “Therapy is expensive and not everyone can afford it; process as I worked through my own issues and with yet, they need to find help,” says Fulvio. “I was getting these women. I felt I needed to go a lot deeper in my own lots of questions on the blog so I started my Question and process and with my own therapy in graduate school to answer Fridays. All the while, I was writing things down become a licensed therapist, which is what I did." on the side. I wanted to put all the questions and all the

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information together in one succinct that I was going to hold place; the idea of a book took on a their hand and say, ‘Look life of its own. At first it was going to I’ve been there; I know be 7 Steps to Binge Eating it’s painful and I know Treatment—based on all those 7 step it’s hard, but we can do books out here. But as I was writing this together, we can the steps, I realized there were way recover...’ That was my more than 7 steps. It’s a complicated intention.” disorder. So I thought I would just include everything here (there are 34 The book is divided into steps in the book). I wrote with the 12 two sections. The first -step model philosophy in mind— helps readers understand take what you need and leave the rest binge eating disorder behind. while the second offers steps—action steps and “I wrote every day, and before I internal steps—to change started writing, I said a little prayer. actual eating behaviors as It helped my Ego, my inner critic, well as internalized that judge who was saying, ‘Who are thoughts and feelings you to be an authority? How are you associated with food and an authority on this subject?’ I with the self. One of the decided, well I’m not an authority, first steps is to give up but I am empathetic, and I want to dieting. Fulvio suggests help other people, and that’s all you trying it for one day, then have to do. I asked the Universe to a week. “Dieting is write through me. I felt that if I could something people cling be a vessel for the information, then to as a support, as a self-object that's all I had to do, just be open and really,” Fulvio says. “People will resonate with different write. If I could do that, then maybe I techniques, different ways into their could leave my ego behind and let Another step deals with the inner healing and recovery. I saw a need the voice come through me. This critic— identifying the critic that is for this book because I have read a endeavor wasn't about me or my ego, telling you that something is wrong lot, I don’t want to say I’ve read this was all about helping people. with you, that you need to change. every book out there on binge eating, That is how I go about working with This voice says things like ‘you are but I have read a lot of them. There is my clients in individual sessions and bad if you binge eat’ creating a so much work out there,” Fulvio that is the way I chose to work on the vicious cycle. Here’s this voice says. She reflects on writers such as book. My intention was to be open, telling you that because you binge eat Geneen Roth (author of When Food aware, allow myself to follow you’re bad and you believe it. And is Love) and Christopher Fairburn direction, almost like following a then self-hatred comes. To cope with (author of Overcoming Binge trail of breadcrumbs left for me. I did this emotional onslaught, you binge Eating). “I wanted to interweave my best to be open in my writing and again. Fulvio suggests you approach their work and offer tangible steps sharing. the concept of judgment and criticism you can take and make happen. I felt by looking at how you judge and the cognitive behavioral stuff was a “It was difficult to write about my criticize others, first. She also helps little dry in my own recovery; yet, I own experience. Here I am the readers establish healthy boundaries. resonated with the tangible need for therapist, I’m supposed to be a blank some assignments to try to put it all slate, and it’s all about the client, but “Life is a lot easier with together.” as a writer that’s not going to fly. boundaries,” she says. “When you People are not going to identify with recover from an eating disorder, you Fulvio explained that there is a the book if they feel talked down to go from either having rigid misperception that women with binge rather than felt with. As a writer, boundaries or no boundaries. I teach eating disorder are all overweight. there has to be some transparency in people how to have loving, helpful, The majority of the people she works order for people to feel heard and adult boundaries and then how to with are at a normal weight, she says. seen. I wanted my readers to feel as if teach these boundaries to their inner “I’ve even had people down right I was there in the room with them, self, their inner child. skinny with binge eating disorder.

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They are not worried about their “You want to recover from a weight, they are worried because place of strength,” Fulvio says. they are out of control with food. “We have our eating disorder in a void, a vacuum, we are alone “I remember working with one with it. We recover with other client who was extremely thin people. When you shine a light and thinking, oh sure, you think on a monster, it’s not a monster you have binge eating disorder, anymore. My intention in writing but you're actually closer to the this book is to help people anorexia side of things, and so recover but also for them to use you call eating one or two the book with other people— cookies a binge. But that was not their therapist, a 12-Step mentor, right. This woman was sitting a friend, a support group—to down at night and eating one or take them out of the isolation. two boxes of Girl Scout cookies after a normal sized dinner. She “And, my intention is for a lot felt absolutely powerless. She of people to find hope,” she says. was spending money that she did “Even if they just can’t do it the not have on binge foods. And, first time they pick up the book although it isn’t always about they can always try it again, it weight, it often is, so it’s not will always be there for them. unusual for a binge eater to binge Success in recovery is all about for one, two, three days, then timing, readiness and starve themselves the other three willingness. I want people or four to compensate—their reading this book to know that form of purging is restriction. A lot work with that issue before wherever they are is okay, even if of my clients who suffer with binge addressing the binge eating. For they are in a place of wanting to give eating have similar personality starters, she offers that your brain is up, even if they do decide to stop structures—they are high not clear and you are not thinking actively recovering. You can't undo functioning, successful women who straight. And, if you need to drink the work that you've already done, eat normally in front of friends and two, three glass of wine every night, your past recovery is always there for family then go home and binge you just won't be present with you. It grows and comes back in alone. yourself to do the steps. “You need a subtle ways. I want people to know lot of support to heal from that if they can just hold onto hope “Eating disorders are very alcoholism,” Fulvio says. “Even if recovery will always be possible.” complicated,” Fulvio continues. you take a year or two to look at your “Treatment is rough. You can’t own drinking, you have to do that expect one thing to work with all first. On the spectrum of things, clients. When I was in my behaviors, compulsive drinking and binge a very close friend of mine was drinking are more serious. You have dealing with bulimia. We talked to deal with that first because your openly with one another. She said, life is in danger in the immediate. ‘How can you eat something and just You have to take care of one coping sit with it? I don’t get it.’ And I said, mechanism at a time. If you stop Leora Fulvio, MFT, is a licensed ‘Well, how can you make yourself binge eating, you might start drinking psychotherapist, hypnotherapist, and throw up?’ Back then, in my head, if more to compensate. You might say, author. She has been treating women you were making yourself throw up, ‘Okay I’m not going to eat for a with food issues since 1999. She you were really, really sick, what I week, I’ll drink instead to relax and it studied creative writing at Bard was doing wasn't so bad.” will keep me from eating.’ I say, College and completed her MA in ‘Let’s help you to stop that first. You counseling psychology at the Alcohol and Binge Eating Disorder need to clean up your brain, be clear California Institute for Integral eyed and clear thinking to come at Studies. She is currently a full time Fulvio is clear that if you are your eating issue from a place of mom (6-month-old and 2-year-old dealing with alcoholism you need to strength.’ sons).

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Reclaiming Yourself from Binge Eating: A Step-by-Step Guide to Healing

Written by Leora Fulvio, MFT

Sasha Dmochowski Reviewed by Sasha Dmochowski, MA

Recovery from an eating disorder maintaining factors. The approach is eat. The second section of the book is a complex process that requires grounded in empirical science but is where a reader assumes a less guidance and support. In her meant to be accessible. Before passive, more instrumental approach. introduction to Reclaiming Y ourself moving into this educational This section organizes skill building from Binge Eating: A Step-by-Step material, Fulvio begins by the into a series of steps that are designed Guide to Healing, author Leora suggesting to her readers that they to be addressed one at a time, and Fulvio reveals her own history of self will want to develop a practice of repeated if necessary. The 34 steps -destructive eating behavior and her mindfulness. Clinicians of differing should be digested gradually; each inspiration to help those who struggle theoretical backgrounds who may chapter might take a week or several with binge eating. With a do-it- recommend this manual to clients and are to be accompanied with a yourself approach, this book provides will find common ground with some journal and writing utensil in hand. practical steps that may help of the meditative and thought Acknowledging that a journey of individuals to stop binge eating, restructuring methods she includes recovery must be deeply individual increase their emotional awareness, here. Fulvio discusses the in order to be maximally effective, and understand why they binge eat. differences between ‘disordered readers learn how to self-motivate Exercises and suggested meditations eating’ and ‘eating disorder’ and also and to more efficiently identify and are included throughout the book to examines what we might consider a manage urges and triggers. Fulvio supplement the text. It should be healthy body, at any size. The may garner some criticism for her noted that this book is not intended to material covered includes strongly anti-diet stance. She defines substitute for the care of a licensed physiological, social, and dieting as “the deliberate act of health professional. psychological factors that contribute restricting food in order to achieve to maladaptive eating, and identifies weight loss,” and feels that as a Full disclosure of having a history the cycles (e.g., binge-restrict vs. non behavior, dieting can be just as of an eating disorder is a calculated -compensatory binge) that may come harmful as binge eating. She risk. Fulvio does this artfully and about through these influences. recommends throwing away the shares her personal narrative with While some of the titles listed for bathroom scale, and she gives great aplomb. As a reader, it is easier ‘binge personality types’ may seem detailed instruction on how to learn to trust the advice of people who overly simplistic at first glance, to eat intuitively. As the steps have walked the recovery path that Fulvio makes a good attempt to progress, readers learn how to their book implements. Organized identify and describe common prevent maladaptive behaviors into two sections, the first part of the personality profiles that an individual surrounding emotions that link with guide offers an in-depth view of the might assume as a binge eater. food, to better navigate through defining characteristics of binge relations with family and friends, and eating, the criteria that comprise the Section One might be adequate on how to handle potential relapse. Self- disorder (i.e. “How do I know if I am its own as an educational tool for monitoring exercises and lists of a binge eater?”), and an explanatory individuals who just want to know alternate or replacement behaviors, as model for both its etiology and more about what it means to binge Continued on page 109

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Body Wise

By Kamalamani

Consuming Passions

“To lose confidence in one’s body is to lose confidence in oneself.” Simone de Beauvoir (2010, 355).

“I'm learning how to taste everything.” Laurie Halse Anderson (2014, 276)

I've puzzled over the psychology of food, body image, female identity, and sexuality since I was little. I grew up with a beautiful mother and grandmother who were absorbed by fashion and being attractive. The language around food consisted of 'being good' versus 'being naughty'. As a girl, I found fashion and food pretty boring; I was a tomboy, roaming the countryside and trotting around on borrowed horses, enjoying freedom and wildness. Freshly- groomed horse was my favourite smell, rather than Chanel No. 5. Fashion-conscious wise, I was a bitter disappointment to my elegant female folk. These days I am repeatedly saddened by the self-hatred and self-harming of so many of my female clients, and a few of the male ones. I'm sickened by the suffering of teenage girls

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and the rising numbers of boys who Then puberty happened. I realised, This messy thinking and armored are starving themselves, some to with some shock and resistance that defense was compounded by a routine death, whilst millions of other my body was changing, and I, too, visit to my local doctor. He confirmed humans in the world are dying of was expected to join the world of what I already feared in my belly: I malnutrition, against a backdrop of women. I wasn't ready to swap my was ‘socially unacceptable’ – I was a rising obesity. The politics of food wellington boots for heels and stone and a half overweight. In fact, and confusion around eating, handbags so I didn't. But, I did his full verdict was that: "it's socially consumption, and nourishment have realise I was severely ill-prepared for unacceptable for a teenage girl to be never been more bewildering in a understanding the unspoken overweight." world full of beings He didn't ask me hungry for love and about eating habits, or connection. exercise, or nutrition. Instead he lectured me In writing this article, I about social find it impossible to talk unacceptability. I about the psychology of failed to check out food without touching on what his judgment the themes of body would have been had I image, gender, and been a teenage boy. identity, and notice the old echoes of fear and What was also shame that go with this emerging for me at territory. I know I'm not that point was a alone in this; in fact, I'm genuine interest in in good company. I nutrition and the haven't met many women workings of the body. who grew up with a Studying biology, and healthy, balanced attitude later for an exam in to food, eating, and their nutrition and cookery, bodies. I've met a few I was fascinated by women who reached nutrition and health. I womanhood largely also realised that I was unscathed but sadly a good cook, which they're in the minority. remains a creative, relaxing outlet. I was Since my girlhood, I've amazed by the been familiar with the workings of the body. latest fad diets. I I loved the intricate witnessed my Mum's diagram-drawing of valiant efforts with the: biology classes and Mayo diet; F plan; and have memories of Hip and Thigh diet, to crazy experiments, in name but a few. I became particular, boiling a a child-expert in food-as- peanut in a test tube to Sketches drawn and donated by Kamalamani the-currency-of-love find out its calorific through day-to-day value. Not long culinary interactions with my assumptions and expectations of what afterward, I decided to become grandmother. Woe betide anyone who it means to be a woman and how vegetarian and became increasingly didn't clear their plates and come muddled that was in my head: a rich interested in the ethics of food and back for seconds. Food was not only cocktail of food, nourishment, body eating. the currency of love but sadly a image, love, and nascent sexuality. powerful bartering tool in the love- My embodied defense was the layer It has taken me the best part of hate relationship between my mother of retained puppy fat between me and three decades to unlearn some of my and grandmother, who traded quite the world keeping others, particularly distorted behaviour around food and ferociously. the opposite sex, at bay. eating and to notice how I used food

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in ways other than for nutrition. I my Mum; she does her thing, and I do nourishment, taking the place of the picked up much more about body mine (and she's a great proof reader. inner emptiness of the ‘hungry ghost’. image, the ideal weight, and 'good' Hi Mum!) But I am also aware of a growing and 'bad' foods, rather than nutrition body of people who want to live and how to eat: eat when you're Where food comes from matters to consciously, to live as simply, wisely, hungry and stop when you're belly me more than ever before. I don't and as lovingly as they can in these starts to tell you it's full. Eat what want to eat food that costs the earth, uncertain times and not consuming you're body wants to eat, rather than even though I do, at times, indulge the earth. what your head is craving or what's with the odd exotic fruit. I love on the adverts. Eat a balanced diet growing our own vegetables and fruit, The Metta Sutta and don't snack between meals. Eat seeing directly the link between seed, because you're hungry, rather than plant, harvest, compost, and relishing If you know your own good because you're sad and alone. The the taste, texture, and nutritional and know where peace dwells rules are quite simple in theory but so value of something freshly picked or then this is the task: much harder in practice if you've dug up, with earth still clinging to its grown up in an environment of roots. I feel so appreciative that I Lead a simple and a frugal life confusion. have fresh food to eat and see more uncorrupted, capable and just; clearly the overused phrase that we be mild, speak soft, eradicate conceit, Understanding eating seems to be a are what we eat. I'm more aware of keep appetites and senses calm. lifelong voyage and interest. Last the 'hungry gap' during the productive year, recovering from a debilitating year which once upon a time would Be discreet and unassuming; virus, I completely lost my appetite. I have caused hunger and suffering to do not seek rewards. didn't want to eat and felt sick. I our ancestors and still causes Do not have to be ashamed listened to my body, and my body suffering to fellow human beings in the presence of the wise. told me what to eat. Mouthful by living in poverty. mouthful, I started eating again. May everything that lives be well! Although, I have found my taste for Learning how to eat and learning Weak or strong, large or small, caffeine and sugar have dropped how to feel safe and nourished are seen or unseen, here or elsewhere, away. In that phase, I realised, vital for a healthy human life; yet, it present or to come, in heights or perhaps for the first time, that I could feels like many of our societies are depths, eat exactly what I wanted to eat. How disordered in our individual and may all be well. embarrassingly obvious, yet it hadn't collective approach to food and been at all obvious to me until that nourishment. This reminds me of Have that mind for all the world - moment, despite the work I've done. what's known as the 'hungry ghost' get rid of lies and pride - This powerful realisation was helped realm from the image of the Tibetan a mother's mind for her baby, by the care of my partner who would Wheel of Life. Hungry ghosts are her love, but now unbounded nip to the shops to buy whatever my creatures with huge, distended, empty body wanted. I was spoilt and bellies. They are said to be constantly Secure this mind of love, nurtured like never before. hungry because their thin necks don't no enemies, no obstructions allow food to pass to their stomach. wherever or however you may be! These days I'm happy to inhabit a Food turns to fire and ash in their middle-aged body. I'm happy to care mouths. They keep seeking food and It is sublime, this, more about what I put into my body nourishment. it escapes birth and death, and how much sleep I get rather than losing lust and delusion burning energy worrying endlessly This desperate image reminds me and living in the truth! about how I mightn't measure up to of the current predicaments of someone else's image of female Western societies. We are constantly beauty. This middle-aged body has a craving and never seem happy or Kamalamani is an embodied-relational few battle scars, but we're no longer contented with our lot. Capitalist therapist, supervisor, facilitator and writer at war. I love it more than I ever have habits of consumption compound this living and working in Bristol, UK. She before, and I love the fact that me and 'hungry ghost' pattern of addicted, has been a practicing Buddhist since her early 20s and loves seeing how age-old my body's storehouse of experiences compulsive behaviour. When the teachings and practices are relevant to are able to support others in getting Buddha met a hungry ghost he is said contemporary life. She works at the into deeper relationship with their to have offered it food and drink that interface of body psychotherapy, own embodied experience in healing was truly satisfying. This food and ecopsychology and wounds. And I'm on good terms with drink also symbolizes inner Continued on page 109

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Somatic Wisdom and the Polyvagal Theory in Eating Disorders

By Inge Sengelmann, LCSW, SEP, RYT

A 52-year-old female with a 36- three two-liter bottles of diet coke per to identify, label, and process year history of anorexia nervosa was day instead of water, and engaged in emotions, acquire skills for referred to me for Somatic excessive daily long-distance interpersonal effectiveness at work Experiencing® after failing to cycling. and in relationships, as well as progress following ten years of expand her nutritional palate, which traditional treatment. The client and Gradually, through the use of is still challenging due to her fear of her former therapist described the Somatic Experiencing (SE) practices, weight gain. Through mindfulness client as ‘stuck’ in all areas in her the bracing responses completed and and body awareness she is now able life: unable to fully restore her began to lessen. We ‘nurtured’ her to give voice to her emotions, and the weight, successfully maintain any job ventral vagal social engagement headaches and stomach pain have all or relationship, or complete desired system by using imaginal exposure to but disappeared. The results seem activities such as remodeling her eye contact with her beloved cat (no miraculous to the skillful home. Her past traumas included human contact felt as safe), which professionals who previously treated disruptions to early attachment, universally elicited a wide smile and her with every tool in their arsenal having been raised by a dismissive softening of her entire body. We also except somatic awareness and and invalidating mother in rural used vocalization and singing, one of processing. In this client’s case, Cuba, which was compounded by the her stifled passions, as a way to adding Somatic Experiencing® as a physiological trauma of severe ‘awaken’ her dorsal vagal complex precursor and preparation for DBT starvation from age sixteen, a and release the vagal break at a pace has made a significant impact on the traumatic head injury with a coma at that she could tolerate. In a few quality of her life and her potential age twenty-eight after a cycling fall, months, she began to mobilize and for a more meaningful recovery. and a high-impact fall from a socialize. She began to notice hunger telephone pole in her mid-thirties cues and to recognize that she could Why Somatic Approaches? when she worked for the local phone not ride for endless miles without company. She presented with nutrition and hydration. She The etiology of eating disorders is somatization of unwanted emotional eliminated the use of soda and began largely unknown. They are multi- experience, which manifested as drinking water. She reduced her faceted and multi-dimensional in recurring migraines, abdominal pain, cycling treks and incorporated more origin, presentation, and response to and slowed cognitive and verbal walking. She remodeled her home treatment. Current (largely cognitive- processing. She had no language to and traveled out-of-state to pursue behavioral) treatments are limited in describe emotional experience other vocational training. She obtained and scope and outcome. Anorexia is than the physical symptoms. Bodily has maintained a part-time job, and considered to be one of the deadliest she engaged in bracing responses— she began dating for the first time mental health disorders – with nearly stiffening and extending her arms since she was twenty-eight. 20 percent of people suffering from and legs with the mildest amount of anorexia dying prematurely from activation—and she avoided all eye She has since been able to complications related to their eating contact. Behaviorally, she restricted participate in a Dialectical Behavior disorder, including suicide and heart entire foods and food groups, drank Therapy skills training group to learn problems (Arcelus et al., 2011). More

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than 27 studies reveal that only 45% either stuck in a dorsal vagal freeze been pre- and/or peri-natal events, or of all bulimics experience full or sympathetic over-activation (fight chronic patterns of threat such as recovery after years of treatment or flight). The war manifests as self- abuse, neglect, and invalidation. (Steinhausen & Weber, 2009). destructive behaviors that are, Early histories of persons with eating paradoxically, conditioned attempts disorders include injuries to the Studies of brain functioning in to maintain the body’s autonomic attachment system, without which the individuals with anorexia and bulimia homeostasis for the purpose of neural pathways that mediate affect also have shown impairments in the survival. Dissociation from bodily regulation cannot develop (Chassler, functioning of the insula and the experience, leading to a chronic 1997; O’Kearney, 1996; Schore, anterior cingulate gyrus (Kaye, disregard of the body’s needs, also is 2000, 2002). Because their pathways 2008), areas responsible for a hallmark of these disorders between limbic and cortical areas of interoceptive awareness, the regardless of where they fall on the the brain are undeveloped, they live integration of sensory information spectrum – starvation and emaciation in a constant flux of dysregulation and emotions, the regulation of in anorexia, binge-purge cycles in that includes a dorsal vagal survival aggressive impulses, as well as bulimia, or binge eating and obesity response that makes persons ‘numb’ behavioral motivation and in the other extreme. Therefore, to most stimuli coming from the gut coordination of motor impulses therapies such as Somatic to the brain, e.g., hunger and fullness (Damasio, 2000; Fogel, 2009; Experiencing® could be critical in signals (Porges, 2010). LeDeux, 2002). The insula is also restoring body awareness and responsible for assigning reward autonomic regulation. Living in a world where hunger is value to foods, a function disrupted in in constant conflict with the ‘thin persons with anorexia who respond Eating Disorders and Trauma ideal’ and where being ‘fat’ in a ‘thin differently to taste stimuli (Kaye, world’ oppresses young men and 2008). Furthermore, these same areas A review of the literature indicates women every day, can be ‘traumatic’ of the brain are largely responsible that individuals with eating disorders in the sense that it keeps a person in a for the perception of the body-in- are more likely than others to have a physiologically-stressed state of space and when impaired lead to history of trauma and, conversely, constant hyper-vigilance. Wanting to symptoms of body dysmorphia, at those with trauma are more likely to restrict food intake and ‘failing’ leads worst, or body dissatisfaction, at best report disordered eating patterns – people to feel ‘betrayed’ by their own (Saxena & Feusner, 2006). making trauma a risk factor for eating bodies. When bodily responses fail to disorders. Any history of trauma is measure up to these impossible This article explores the adjunctive correlated with increased levels of standards, eating disorders brew. use of somatic approaches to restore impulsivity and dissociation, both of the nervous system’s capacity for which increase symptom severity, Case Study: Bulimia autonomic regulation, thereby longer length of illness, and poor eliminating the need for symptoms prognosis (Briere, 2007; Everill et al., In bulimia, food serves to soothe believed to serve that function. Eating 1995; Lockwood et al., 2004; sympathetic over-activation but disorders are characterized by deficits Mantero & Crippa, 2002). because satiety responses have been in the self-regulation of food intake, These rates may be higher when interrupted a binge occurs, leading to emotion, cognition, and behaviors. using a broader definition of trauma a purging discharge that serves to The body is the battlefield for the that includes any event that taxes the expel uncomfortable sensations from uncontrolled emotions, and motions person’s organismic capacity to the body. Once purged, the person of incomplete survival responses— protect their integrity or is perceived experiences the numbness the autonomic nervous system is as life threatening. These may have characteristic of a dorsal vagal

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whether the trauma memories A 56-year-old widowed woman consisted of thoughts, sensations, or with a long history of binge eating images. She replied images, stating and struggles with weight that one predominant image caused management described her her the highest distress. She was experience as one of core emptiness instructed to “freeze” the image and and desperate loneliness. Her longing place it at a distance of her choice, for connection and to “fill the void” granting her the power that she led her to nightly binges that filled lacked during the initial event. This her up physically (which she allowed her to begin to tap into the recognized only when extremely full) body sensations associated with the but not emotionally. Every episode experience and safely discharge them, increased her despair. Additionally, while also helping her differentiate she described feeling invisible to the (or uncouple) the stress of life- world around her when she was threatening fear from the stress of a growing up and needing to generate response. Because there is evidence final exam; this allowed her to greater body mass and “take up a of a destabilization of the vago-vagal tolerate returning to school. Next, we bigger space” in order to “be seen.” feedback loop in bulimics (Faris, addressed the impulses to self-injure, Sadly, because of social discomfort 2006, 2009), relapse is common and which she described as serving a with largeness, she had become a beyond the locus of control of the function to orient to the source of the target of bullying to those who would sufferer once the binge-purge cycle threat (“at least I know where the shame her for her size and of greater becomes ‘hard-wired’. This requires a pain is”), as well as to provide invisibility to those who would just titration of the nutritional re- numbing, which she described as look away to avoid their discomfort. education phase within the client’s “floating in a pool of warm water.” Gradually, through mindfulness window of tolerance to try feared She was “prescribed” to float in her training to increase interoception, and foods and tolerate fullness. pool daily with mindfulness to body movements to engage a sense of experience the soothing effects. core strength and embodiment, she In my experience, my bulimic Finally, she was asked to use began to notice and become aware of patients have the highest states of expressive art to “yell” the “NO!” she the fact that “the emptiness is not so hyper-arousal and require significant was unable to voice. Together, these empty.” Her ‘authentic self’ began to assistance to develop somatic and other sensorimotor interventions fill her, and she felt less need to binge grounding, orienting, and settling allowed her to quickly feel that she and greater satiety when eating foods skills before they can be helped to could ‘move on’, discharge from that pleased her. discharge the activation they treatment, and return to college. experience, which is usually expelled Summary through excessive exercise, vomiting Case Study: Binge Eating Disorder or laxatives until other skills are The use of mindfulness and somatic developed. Overweight/obese compulsive practices that increase body overeaters and binge eaters, on the awareness, assist in the regulation of A 22-year-old was continuing to other hand, display similar shutdown autonomic hyper-arousal or hypo- have intense urges to purge and self- or disconnection from internal states arousal, and discharge the ‘un- harm through cutting after almost one as anorexics. Anorexics become digested’ survival energies of trauma, year in residential treatment and was significantly aroused by the feeling of is quickly gaining relevance in the afraid to leave treatment. She was food in the stomach, while overeaters treatment of eating disorders. Yoga, frightened to address the childhood are triggered by the sense of the expressive arts and psychodrama, sexual abuse trauma that led to her emptiness and hunger – even if at a movement and dance therapies, and symptoms. Learning that she could more subconscious or autonomic integrative mind-body process her trauma response body level. These groups require help psychotherapies such as Somatic somatically, without verbally having in increasing awareness of arousal Experiencing® (Levine, 1997, 2010) to tell the story, increased her states through skills in tracking are increasingly available at treatment willingness to see me. I asked her to bodily sensations mindfully so these centers. These approaches increase “walk-and-talk” outdoors in order to arousal states can be safely interoceptive and proprioceptive increase orientation to safety in the discharged and not induce either awareness through the use of sensory- here-and-now and movement to starving/dieting or overeating motor tracking skills that strengthen decrease the sense of immobilization behaviors. the insula, the anterior cingulate by fear. While walking, I asked her gyrus, and the connections between

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and cortical areas (Holzel et al., 2010).

Regardless of the eating disorder presentation, somatic awareness to deepen therapeutic interactions, provide access to disconnected emotions and sensations, and nurture a sense of ‘safe’ embodiment becomes crucial to healing. Overcoupled and undercoupled aspects of the person’s experience (affects, sensations, images, behaviors, and meanings) can be gradually integrated to restore a person’s sense of wellbeing and resilience. This includes the internal hunger, fullness, and satiety cues necessary to establish long-term recovery and end the dieting, starvation, binge eating, and purging cycles.

To summarize, because eating behaviors have been equated with stress at a sub-cortical, mid- brain level, it makes sense to incorporate practices that take patients ‘beyond talk’, especially when the reasoning, cortical brain is off-line due to starvation or malnutrition. Since the body is the battleground of the emotions, therapists and their clients might benefit from understanding the language the body is speaking.

Inge Sengelmann LCSW, SEP is a licensed clinical social worker, Somatic Experiencing® Practitioner (SEP), and yoga teacher focusing her practice on the treatment of eating disorders and trauma. At The Counseling Group in Miami, she is a founding member of an intensively-trained Dialectical Behavior Therapy (DBT) consultation team and the DBT outpatient treatment program for eating disorders. Inge is in the process of completing the ParaYoga Master Training curriculum with her teacher, Yogarupa Rod Stryker, Eating Disorders is contemporary and wide ranging and takes and has been initiated into the Himalayan Tantric a fundamentally practical, humanistic, compassionate view lineage of Sri Vidya. Tranta’s main focus is of clients and their presenting problems. You’ll find a accelerating transformation using ancient wisdom multidisciplinary perspective that considers the essential practices tailored to each person’s specific needs. cultural, social, familial, and personal elements that not Weaving ancient and modern wisdom, Inge integrates only foster eating-related problems but also furnish clues the latest developments in the field of affective that facilitate the most effective possible therapies and neuroscience with mindfulness and yoga practices to treatment approaches. inform her work with clients. She has been active in the Miami Chapter of iaedp (International Association of Eating Disorder Professionals) and teaches workshops A distinguished international editorial board ensures that for practitioners as well as clients. She has presented Eating Disorders will continuously reflect the variety of locally, nationally and internationally on the topic of current theories and treatment approaches in the eating eating disorders, somatic psychotherapy, and disorders arena. From anorexia nervosa to bingeing to yo- integrative mind-body-spirit healing. For more yo dieting, editors and contributors explore eating information about Inge visit disorders from a number of exciting, sometimes www.IngeSengelmann.com unexpected, and always thought-provoking angles.

References on page 109

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Sensory Feeding and Eating Disorders

By Rodolfo Garcia Otero, MA

According to the DSM-5, Feeding and Eating Disorders appears as a spectrum category. Clinically we assist clients presenting with more than one specific disorder. Besides transitioning between anorexia nervosa, bulimia nervosa, and binge eating, clients often experience anxiety, mood, attention, and sleep disorders. This situation represents a real challenge for diagnosis and treatment. Looking to increase the efficacy of my intervention, I started tracking co-morbidity traits and noted that every client I worked with, regardless of diagnosis, also presented with high levels of anxiety and low levels of self- esteem, as scored on anxiety scale tests provided by EMDR and on self – esteem questions during the intake, and clients’ statements during their treatments.

Based on my findings, I developed Multilevel Tone emotional worlds are connected through the etheric one Calibration—Symptom and Trauma Management (MTC- (cognitive). Some techniques are based on traditional STM), as a body psychotherapy and sensory psychology Chinese medicine. Some on current techniques including tool founded on Theosophical practice. I can use each the following: Thought Field Therapy (TFT) / Emotional component alone (MTC and STM) or together Freedom Technique (EFT); Emotional Energetic depending on the context. Theosophy proposes that Reactivation Technique (TREE); reflexology, and cranial human beings are comprised of many bodies vibrating at sacral therapy (CST), which are based on balancing the their own spectrum speed and substance amplitude. Each somatic body with the emotional one through meridian spectrum has a body following the structure pattern of the (somatic – cognitive) stimulation. next subtler body. Theosophy states that the sensorial and

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I incorporated five body oriented bilateral exercises from this through simple somatic – cognitive techniques within my intervention perspective. exercises. I am also convinced that as tool including the following: basic trust (self-esteem) increases, BMSA (Brief Multi-Sensory anxiety decreases, sharing an inverse Somatic Experiencing, Trauma Activation): developed by Dr. proportionality. While basic trust Healing (SETM): developed by Dr. Joaquin Andrade (Uruguay), Dr. improves, will power, initiative, and Peter Levine, this perspective is Maarten Aalberse (France) and Dr. limit setting become stronger. Being based on the regulation of the Christine Sutherland (Australia), this stronger allows clients to better autonomic functions and of perspective is a neuro-physiological control their thoughts, humor, consciousness (self-regulation). technique designed to use sensory anxiety, and their frustration Regulation inspired calibration. stimulation to interrupt conditioned tolerance is enhanced. Regulation is about the balance brain patterns. It suggests that between the sympathetic and emotional centers of the brain can be From Somatic Experiencing® I parasympathetic autonomic accessed by senses, equilibrium, and learned that the first goal for a subsystems. Calibration is about the orientation. Flooding the amygdala healing process is grounding and the constrictive force, tone/relaxation, of through sensory stimulation produces second is awareness. From tone the organs and glands regulated by desensitization. calibration perspective, grounding activation – deactivation signals of means connecting with solidity; the ANS. Activation signal is Havening Technique: developed by awareness means focusing attention constrictive, and deactivation signal Dr. Ronald A. Ruden, this to certain stimulation to let it get into is relaxing. perspective also stimulates epicritic the brain for later processing in the neuron circuits. While the client is amygdala during the sleeping stage to Calatonia: developed by Dr. Pethő describing a traumatic event, the generate tone and relaxation tension Sándor, this perspective specializes therapist uses gentle touch to manage for organs and glands. If attention is in gentle or subtle touch to stimulate any resultant traumatic affective not present, the stimuli do not access epicritic sensory circuits. This charge. the brain, provoking lack of material stimulation provides relaxation to the to develop somatic tone for proper global autonomic functioning. Combining these tools with MTC, I autonomic functioning. Combining General sensory pathways ascend have been able to strengthen clients’ these two concepts with my from the spinal cord to the thalamus self-esteem as well as their experience with the autistic and cerebral cortex. These pathways autonomic activity (tone/ relaxation population I worked with during my are grouped into two categories based of the constrictive force of organs 18 month intensive practical training on the type of information conveyed: and glands), will power and control. program at the Devereux Kenner epicritic, which is concerned with Self – esteem is the appropriate term Center, I developed Grounding discriminative tactile and kinesthetic to address attachment issues. But for Awareness Exercises. I was taught proprioceptive senses; and my perspective, ‘basic that Autism is defined as sensory protopathic, which transmits pain, trust’ (Erikson, 1950) 1 is the integration issues. Through trainings temperature, and itch. The appropriate term to find a somatic and professional observations I protopathic may be an early warning sensation (categorized as solidity, arrived at the idea of calibrating the indicator of external aggression and firmness, and strength) as a reference autonomic functioning through the is in charge of the most primitive and for emotional strength (trust). By senses. Through daily firm sensory – diffused sensibility. Calatonia providing clients with firm sensory cognitive stimulation exercises (i. e., oriented me in adding protopathic stimulation throughout treatment, spending 5 minutes being aware of stimulation to fully stimulate clients they improve their autonomic activity solid surfaces: floor, wall, or table, in order to achieve a healthy state of and basic trust, meanwhile reducing while being in contact with them) being. their anxiety level. Daily behavioral performed at home, clients enhanced changes reported by my clients made their global condition. Calatonia and EMDR (Eye Movement this observation quite evident. For Havening Techniques stimulate Desensitization Reprocessing): this reason, I believe that anxiety is epicritic neuron circuits through developed by Dr. Francine Shapiro, the expression of unbalanced tone subtle or gentle touch, so MTC starts this perspective is based on balancing (mainly lack of strength). From a by stimulating protopathic neuron the activity between both brain multilevel perspective (theosophical), circuits through solid touch then hemispheres. Each one has its own somatic tone is strength, cognitive finishes with the epicritic ones. characteristics, complementing the tone is attention, emotional tone is Epicritic circuits signal the sense of other half. Traumas and signs are basic trust and sentimental tone is relaxation to the ANS distinguishing related to inter hemispheric non- dignity. For this reason, all levels can the different kinds of stimuli. integration issues. MTC acquired be strengthened at the same time Protopathic neuron circuits provide

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tone, taking the body as a whole in positive tone is integrated, clients terms of solidity/strength and cease with their compulsive suffering resistance (positive and negative tone behaviors for becoming useless. As respectively). Positive tone provides this calibration has immediate To be able to strength, and negative holds it effects, clients need to be counseled through time. If levels of trust are in how to adapt to the new healthy low, clients cannot relax—they condition. This new condition brings perceive relaxation as a threat. To be initiative, will power, and planning. relax, clients able to relax, clients must trust that Clients feel that they want to recover nothing will happen if they withdraw the wasted time while being their controlling attitude. Once inhibited. As clients change, their clients are able to trust, they are relationships are affected. Some of must trust ready to relax. Looking for the the relationships become distant, antecedence of panic attack episodes, while new ones start to build. It takes I realized that a sudden disconnection fewer sessions to alleviate pain than with the controlling behavior was the to guide clients toward the better that nothing trigger. Clients feel that the attack outcome possibilities (evolution). comes from out of nowhere; Regarding the DSM-5 Feeding and obviously, as their controlling Eating Disorders diagnosis, MTC’s awareness vanishes for a while, they application is highly useful for the will happen if are unable to recognize the above mentioned reasons. Dr. antecedence. By providing firm Joaquín Andrade suggested that stimulation, clients are able to relax many eating disorders may be deeper, and the effects of relaxing considered part of the Obsessive methods become more effective Compulsive Disorder (OCD) they withdraw without causing disintegration threats spectrum. This is an important (Winnicott, 1960).2 distinction because of all the mental health tools I know, MTC is the best Clinical experience has shown me with this spectrum. Overeating is not their that in cases of firm integration considered a disorder in DSM-5; they deficit, clients reinforce their now recognize binge eating disorders negative tone (unpleasant sensations) as well as feeding disorders including in order to simulate the positive pica rumination and avoidant/ controlling tension or tone (strength). Clients restrictive food intake disorder. The wrongfully address lack of firm DSM-5 defines a binge as a sudden integration by tensing muscles compulsion rather than a persistent (mostly upper back, neck, shoulders behavior. For people dealing with an attitude. as well as through bruxism— overweight condition, Claudia grinding their teeth), holding large Quiroz, LMHC, MA, founder and amounts of suffering, increasing director at Centro ATC Mental controlling behavior, and/or Health Services, developed a Weight Once clients increasing thought rigidity. The more Loss Program called Hipnoslim strength they need, the more painful Plus 3, based on hypnosis (implanting tension is generated to compensate through a hypnotic state a virtual for the dysfunction. This is the source gastric band) and sensory psychology are able to I found for masochism. Meanwhile, oriented techniques (MTC, EFT, and positive tone (strength) is low; pain is Aromatherapy). After four years of a need to keep the “sick MTC practice, she realized that it homeostasis”. The emotional was the main tool to strengthen trust, they are negative tensions most used are self- clients’ will power, attention, and pity, guilt, and anger. To avoid confidence prior to the virtual disintegration threats and implant. MTC exercises became the overcompensating behaviors, I pre-hypnotic-implant requirement for ready to relax. propose firm stimulation without initiating the program along with the pain in order to accurately feed the medical exam. During the weight loss brain in charge of providing tone/ process, clients often go through relaxation to organs and glands. Once periods without results (plateau

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periods); they usually feel upset and  Children are more exposed to Being aware of the movements and discouraged. They also feel like this digital activity rather than body sensations when occasionally falling back into somatic activity temptation. Clinical experience has Being aware of the sensation while demonstrated that clients who Lack of certain kinds of stimuli drinking and eating practiced MTC easily overcame these provokes autonomic malfunctioning. obstacles and were able to complete Awareness is also being affected by Spending more time with real people the program. the new lifestyle; thoughts are being rather than with virtual friends digitally disconnected from somatic Over the last 50 years, technology sensations. Sensory awareness Spending more time being aware and comfort-seeking behaviors have integration becomes insufficient for rather than being automatic seriously impacted our sensory proper autonomic functioning. needs. Technology is narrowing our Sensory Feeding and Eating daily somatic experiencing by Disorders refers to poor sensory We do not just eat replacing somatic interactions with awareness activity. I consider these food; we also eat the virtual ones. Poor sensory stimulation as signs of sensory malnutrition. provokes tone deficit for self – Sensory Feeding and Eating world though the regulation. Touch screen technology Disorders is the proposed diagnosis is the most harmful stimulation for for present and coming generations. awareness of our reducing touch spectrum to a single By providing the missing somatic senses. mode. The screen can only produce stimulation, clients’ autonomic one sensation; there is no difference responses reach healthy status. For more details, visit www.mtcpsy.com in temperature, texture, or solid/ Sports, dancing, and other somatic subtle states. The amygdala is in activities are recommended ways to Rodolfo Garcia Otero is a licensed charge of integrating sensations to prevent sensory disorders. psychologist at Buenos Aires, Argentina. the ANS through sensory digestion. He has been involved in Theosophical Daily sensory input is classified The best sensory diet should practice since 1988. His intention to during the sleeping/dreaming process include epicritic and protopathic find the intersection between science and in order to provide different levels of neuron circuit stimulation. For Theosophy, made him develop constriction and relaxation to the appropriate stimulation of the the Theosophical - Scientific Paradigm (TSP). To strengthen the scientific ANS functioning. Comfort-seeking epicritic circuits, any sense is area, after getting his degree, he has been behaviors are also withdrawing firm recommended for being able to researching body psychotherapy sensations from daily living: bodily understand subtleness. But for and sensory psychology perspectives. protopathic ones, sense of touch is His latest development was Multilevel  Shoes are making our steps recommended over the others for Tone Calibration (MTC), Symptom and softer, blocking the firm being able to bodily understand Trauma Management, a powerful sensations on our feet solidity and firmness. Pain is a mental health tool. sensory threshold that indicates a  Water’s temperature is almost limit of tolerance. I strongly End Notes: always the same (shower and recommend obeying this limit. 1 Erik Erikson: “Childhood and Society”, fridge) Healthy strength must be developed 1950. “The eight stages of psychosocial through repetition of painless development” Stage 1 - Basic trust vs.  Daily somatic activity has been stimulation. Healthy resistance is the mistrust. reduced to the minimum through one component that was able to Internet and delivery switch its development from 2 D. W. Winnicott: “Ego integration in suffering to repeating. Awareness is child development”, 1960 “Ego”, 2 -  Many meetings are being the key ingredient for this diet: Integration, 4 - Unintegration and replaced by video conferences disintegration Being aware of the somatic 3  Pictures, letters, agreements, sensations while taking a shower www.hipnoslimplus.com “Hipnoslim” books, music, films, etc. are offers natural and permanent weight loss becoming digital Being aware of every smelling through the virtual gastric band and change MTC. “Plus” offers resolution for  Parents spend less time on child anxiety, mood, sleep, and attention rearing Being aware of solid stimulation disorders as a positive side effect of the using floor, walls, and tables program.

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Are Eating Disorders Truly a Thinking i r?

An Interview with Judith Ruskay Rabinor, PhD

By Nancy Eichhorn, PhD

A Moment in Therapy:

A 48-year-old woman was slated to attend a black tie event, a fancy fund raiser for work; he didn’t want to go. She spent her day consumed with thoughts about leaving work and going e to eat. Dr. Judith Ruskay Rabinor, an eating disorder specialist for over 35 years, had her client slow down as she recapped the story to have her think about her thinking oce

“Eating disorders are a thinking psychoanalysis, feminist theory, what was wrong with her? Why disorder,” says Rabinor, founder of cognitive behavioral therapy, and a can’t she get a date? She di t the American Eati Disorders wide variety of trauma treatment have the necessary coping Center of Long Island in New York strategies when faced with an City and Long Island. Rabinor, who “She wanted to go home and eat anxiety provoking experience. So, considers he therapeutic because eating functions to both he bypassed all that, overrode her style a mix of experiential, relational, help her relax and avoid the stress feelings by thinking about what spiritual, and practical, also notes an if this event,” says Rabinor. “She she would eat—would it be alliance with The Relational Cultural wouldn’t have to go, wouldn’t brownies? No, chocolate chip Therapy of The Stone Center. have to get dre e up and feel fat cookies? No, wait, maybe she’ll go According to Rabinor’s website, thei (she is not fat). This is a good home and take a nap and the eat philosophy states that a sense of example of how people with eating ice cream. All of the emotional inner connection to oneself, to others, disorders pe more time sitting work that should be done was set and to the universe is a central and thinking about eating as aside by thinking a organizing feature of human life. opposed to dealing with the reality strategizing This connection helps people develop of thei feeli This young connections t el (thoughts, woman felt scared and inadequate. “Instead of finding someone to go feelings, history), to others, and to She was afraid of being alone a along to the event, or finding other everything this universe has to offer wondered why she was always single women who ere going that enhances a sense of aliveness, alone and not in a relationship. She (which there would have been), or vitality and joy. Rabinor bases her wondered why her last three another couple she likes to spend eating disorder treatment relationships didn’t work out— time with so that she could have

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“The heart of the work is the highlighting how the avoidance of their feelings is protective and destructive. They can think about throwing up a eating and not think about the real life problems that impact everyday life.”

possibly wound up having a good And life offers all kinds of triggers teenagers, but now I’m eei time, she bypasses it all with resulting in anxiety, depression, more women in their 30s. I talk thinking about She’s not uncertainty, fea abandonment, with colleagues who have also even saying, ‘I’m a mess, I’m a betrayal, frustration, anger. Take been working with eati di failure, I’m alone.’ Saying this for instance graduating from high for 30 plus years, and they are would be step up, a advance in school a going to college. This seeing 45 to 50 year old women therapy. Eating disorders often life changing event often triggers who have been livi with eating pose psychological challenges. anxiety about leaving home and disorders since their teens. Sure These women t feel okay faci the challenges of living with there’s a genetic vulnerability, but feeling their feelings or thinking strangers, performing in a new if becomes a habit then it becomes their thoughts about their feelings learning environment, becoming a way of life. so the solution t the problem is to part of a new social network and lose eight. maintaining lifelong friendships “Many women in their 50s feel despite geographical distance. ne hopeless that they can never stop. Rabinor’s clients shared that They don’t understand they “If you fall off your bike and she’d gone shopping with her mom scrape your knee, are you going do binge, vomit, or starve it. They and bought a quilt to take t are smart, well-functioning. They to put an ice cream cone on it school. When Rabinor asked her if instead of a Band-Aid and t ta what triggers it. she was feeling any anxiety about But it becomes a pan defense; it’s mercurial?” going, the response was She not about one thing anymore, a asked her several times, and when they may never get their body used This is a question Rabinor asks the client queried why the her patients over and over again to to not responding in this way. They repetitive questions, Rabino become resistant t change—they point out the distorted thinking the shared her own quilt t through use of an analogy. They come to therapy and want to tell think the ice cream cone is the their same story over and over, but “When I went to college, I they t ant to go home and do way to treat the wound, and remember sitting in bed there’s always a wound the homework to change.” underneath my quilt. I got this leg underneath the eating disorder. ‘I camp a realized that it had feel fat’ covers the emotional Looking at eating disorders from resulted from all the tension I felt a neurobiological point of view, wound. There’s the magical about leaving my parents and thinking that my life will be so Rabinor says the pathways home. I tol her my story because bad feelings become much better when I’m a size 6 I was trying to normalize the again. Sure if you ei 200 blocked and new pathways result experience. It didn’t seem to take directing the re e t eat. The pounds and you lose 100 pounds, but then asked her about her your life will be different, but response becomes hard wired into eating, and she said that she didn’t the system; other reactions and most eating disorder people are know why but she threw up that normal weight who are torturing responses to life are lost. Instead of m thinking, ‘I need to call someone, them elve . or talk a long walk, or breathe and “Thinking about eating is listen t some music until the “The heart of the work is gratifying because you don’t have highlighting how the avoidance of overwhelming sensations pass and to think about and figure out real the underlying emotions can be their feelings is protective and life issues,” Rabinor says, destructive,” Rabinor says. “They processed,’ the response is to run to stressing the sense of denial and food (or away from food as in the can think about throwing up a deflection in regards to feeli eating and not think about the real case of xia

life problems that impact everyday “I’ve been at this for 35 years life.” It’s the same with alcoholism, now. I used to work with a lot of Rabinor says. Kids who are

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drinking a lot in high school But that isn’t the case. They people feel so lost, so overwhelmed, college have not yet created a deep, want the wedding to be their way, at and eating is so primitive, soothing, hard wired reaction to life. She can their location, with their invite She she a Spiritual celebrations and help them live their life without didn’t connect that she as throwing bonding through eating have been binge drinking. Drinking is not just up again because she was mad at her part of our lives since the dawn about drinking, it’s about thinking, mother. She a not connecting the ma too. Readi Rick Hanson’s book emotional upset with her nervous entitled, Hardwiring Happiness: The system not handling the stress and “A nice meal is like a spiritual New Brain Science of ent ent t i homecoming,” Rabinor says, then Calm, and Confidence, and adds that for someone livi with an respecting a current neurological Rabinor has written extensively eating disorder there is never a nice saying inspired by Donald e about eating disorders. Her book, meal. It’s like a spiritual quest, she “neurons that fire together wire entitled, A Starving : Tales says, tied into the calm comforting together,” Rabinor brings Hanson’s of Hunger, Hope and Healing in place of eating. “It’s more calming to work into her thera e i Psychotherapy, is based on eight of think about having a brownie tha her patients’ stories. She often has confronting your boss,” she a “A patient came in and talked about her current patients read the book,and sitting on her couch with her at times she reads pa age from the “I’ve been doing this since the late boyfriend and petting her cat (She text aloud to them as way to share 1970s and now it’s 2014,” Rabinor started throwing up at age 11 and is someone else’s experience, to find a says. “And we still reall don’t know now 26 years old.) She explained that commonalit and normality in the why people develop eating disorders, she was ha sitting there petting experience, and a way out. Many of and while we have learned a lot, we the cat. I took a page from that book her patients feel shame because the know what we can do to heal and photocopied it and showed her leave the office feeling that everyone.

that she knows how to regulate her everything is fine, and they can Another t nervous system, she knows how to develop the capacity to think thei calm her nervous tem I thoughts and feel their feelings, and “I received an email from a young said, ‘Let’s try an experiment. I want then something triggers them and woman I had seen 30-35 years ago. you to go home and practice petting they throw “I tell them our job is She wasn’t sure I oul remember the cat, a email me every day: Did to be a detective and find out what her. She wanted to thank me. When you do it, when, did it work etc.’ She the triggers are,” Rabinor a returned the following week a said we met, she was dealing with drugs, that it was the first week she hadn’t A Spiritual Cri i alcohol, a an eating disorder. She thrown up. I saw her yesterday in a wrote, ‘You helped me change. You frenzy. he engage and her According to Rabinor, one of the gave me the tools I needed that have parents had initially said it was her triggers is feeling lost and alone. helped me my whole life. You were wedding, she could do it her way. We’re living in a culture where my doctor and my friend.’ I almost fell over at the thought I wouldn’t remember her. I responded and said, ‘Of course I remembe I wrote a paper on you and presented that paper at a professional conference.’ emailed her that paper. I told her that I would love to write another book about what helps people get better, and I asked her, ‘What helped you?” and she replied, ‘You had confidence in me ”

“I was out with some very good friends, a couple ages 60 and 68, who are now seeing a c e counselor, and they just love this woman. I asked them what makes the counseling so good, hat is it about Continued on bottom of page 73 Stock photo from Dreamstime

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A Starving Madness: Tales of Hunger, Hope and Healing in Psychotherapy Written by Judith Ruskay Rabinor, PhD Reviewed by Samah Ahmed Ikram

Samah Ahmed Ikram

Judith Ruskay Rabinor is a clinical psychologist, author, consultant and professor. She has conducted lectures, workshops and seminars worldwide. She received her PhD from Fordham University in 1978, after which she began to develop a specialty in eating disorders. She is the founder and director of the American Eating Disorder Center (1993), which has offices in New York City and Long Island.

In 2002, motivated by her experiences with patients Rabinor wrote, A Starving Madness- Tales of Hunger, Hope and Healing in Psychotherapy. It explores the healing process sufferers of eating disorders go through. It is an honest approach that reveals her own vulnerabilities while in session. This book allows the reader to take a seat in Rabinor’s mind as she tries to assess her patients. She breaks down the otherwise confidential walls of therapy sessions as she attempts to determine the root cause of eating disorders.

She illustrates in her book that she continues to be “struck” by the intricate interplay of familiar, cultural, a form of self-expression. She argues that telling stories psychological, and biological factors that contribute to enhances the value of an experience and each time we the problem. The stories of patients enforce the share a story we get a step closer to “buried facts and importance of interpersonal relations as a means to feelings”. She also illustrates that thinking about the past “nourish” deeper parts of our selves. Although she masks with a witness can often be different than when alone. the names and identities, the tales are based on the lives She explains the traumatizing effect reliving the past can of real people and represent the many attributes of eating have, but assures the reader that with the right support disorders that have become a part of our “cultural and guidance, clients can learn to express themselves and landscape”. heal. She uses techniques such as journal writing, guided imagery and EMDR (Eye Movement Desensitization and The stories of the patients she writes about echo the Reprocessing) to help her clients through the process of idea of cultural stereotypes and the desire some have to healing and writing a new narrative for their life. fit a certain mold. While she addresses the impact culture has on eating disorder, she also writes about the other This book is divided into eight chapters, each of which challenges her clients experience such as sexual abuse tells the story of a patient. Among them is a fifteen-year- and neglect. old girl who suffers from anorexia, a woman in her fifties who secretly suffered from bulimia for more than ten years, a thirty-year-old compulsive eater traumatized by For Rabinor, storytelling is the oldest healing art. It is her childhood memories and, a patient who despite

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therapy remains anorexic. Also In addition to her emphasis on the age ranges and clarifies her own compelling are stories about a college process of telling stories, Rabinor misconceptions regarding prevalence aged woman and a man who must urges her clients to share stories not of eating disorders using patient case learn to cope with struggles including only through words but also through studies. For instance, she addresses compulsive exercise, sexual abuse, gestures that “contain imprints of our the fact that people in old age can and self-mutilation. past”. In one session, she explains to also suffer from them. In addition, a client who binge eats that listening she tries to combat the stereotype that Each story begins with quotes to the body is crucial because talking eating disorders only affect girls by about self-discovery and hope. These sometimes distracts us from a deeper including a story of a male patient. work well to rejuvenate the mind of pain. Together Rabinor and her client Each personal story runs through a the reader at the end of a patient’s imitate the movement involved in sequence of events from why they are difficult tale and also create the mood binge eating—“reach and grabbing”. in therapy to their process of for the next one. Each patient is This silent repetitive story telling acknowledging their eating disorder complex and individualistic. technique enables the client to and connecting with their deep-rooted However, the problem they all deal connect with early memories of emotions. This gradual shift with is their inability to express their reaching for food for comfort while illustrates to the reader the time it feelings. They use food as a tool to her mother lay sleeping. This method takes for a patient to reach some suppress their emotions. enables her to connect and express degree of healing. She discusses storytelling as one of her emotions, instead of turning to her primary tools in therapy sessions. food. A Starving Madness -Tales of “Writing is an axe to break the frozen Hunger, Hope and Healing in sea within” is the quote that begins Rabinor reveals personal anecdotes Psychotherapy provides an intimate the story of Becky, a fifteen- year-old throughout the book. She sees story glimpse into the lives of individuals anorexic who heals through telling as a two way process that who struggle with eating disorders. It storytelling. Although Becky is enriches the lives of both the sufferer is a comprehensive guide for initially on guard, Rabinor uses the of the eating disorder and therapist. professionals in the field as well as technique of writing to cautiously As the book progresses, Rabinor those wanting to help themselves or a penetrate the wall she has put up. She confides in the reader and exposes her loved one with an eating disorder. It tells Becky to write about her feelings own vulnerabilities as a therapist. She is a book parents can use to educate when she is about to eat. Becky’s illustrates the continuous journey of themselves about the symptoms of journal entries initially focus on her healing that patients with eating eating disorders as well as the steps fear of gaining weight. As she disorders go through. In a majority of they should avoid and those they continues her therapy sessions, she her stories, patients were able to should take to allow healthy growth becomes more able to identify her reconnect with their emotions. of their children. Readers vicariously loneliness and hunger for attention. However, she also gives examples of step into the position of the characters Rabinor reminds Becky to be with her patients who continued to struggle in this book. The language and style feelings as she voices experiences she with their eating disorders even after are simple yet creative, which also once silenced with starvation and months of therapy reflecting on their makes it accessible to many exercise. As a trusting relationship past issues. Despite the challenges audiences. develops between therapist and client, she encounters along the way, Becky is able to connect and express Rabinor remains optimistic and This book was incredibly insightful. her own emotions. reflects: “wounds can be a source of Rabinor takes something as simple as connection that enhance rather than storytelling and caters it to her One of the most important hamper” her capacity to empathize patients according to their needs components to storytelling is with patients. By doing so, she through writing, gestures, and listening. Rabinor exemplifies this in humanizes the role of therapists, and retelling of stories, and helps them her story with Mia a nineteen-year- makes a choice to share personal heal. Her words remind the readers to old who was both bulimic and experiences and strategies for growth. have faith in themselves. For each involved in self-mutilating behaviors. struggle she faces in session, she Rabinor realizes through her sessions The dedication she gives patients is offers a solution and further explains that Mia needed someone who would moving as she caters to them the use of certain methods. This is listen and pay attention to her needs according to their individual needs especially helpful for educational in therapy (unlike other therapists and is sensitive to the fact that a purposes. Rabinor’s reflections before who she felt had their own agendas). technique that worked for one patient and after the session provide a deeper She enforces the importance of being may not work for the other. She context to her interest and an active listener, which helps build a illustrates stories of people from all qualification in the field. These bond between therapist and patient. stories remind the reader that

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Ikram continued from page 72 although a gradual process, with motivation and guidance they can heal. Samah Ikram is an undergraduate student at Mills College in Oakland, California. She is pursuing a psychology major with a minor in government. Samah strongly believes in psychotherapy and self-expression through visual arts. She is especially interested in the link between early childhood trauma and eating disorders. She is currently a visiting student at Columbia University. Her expected year of graduation is Fall 2015, after which she intends to attend graduate school.

The Institute for Embodiment Studies is a non-profit educational organization dedicated to advancing interdisciplinary scholarship in the field of embodiment studies. Through education, research, and community engagement, the Institute provides an international forum for academics, practitioners, and community leaders to share knowledge about the role of the body in human experience. Founded by Dr. Rae Johnson.

http://www.embodimentstudies.org/

Rabinor continued from pg. 70 patients, for her patients, a and schools, including Harvard Medical together they can hopefully rewire School of Continuing Education, The her that makes it so helpful? And their neurological pathways to Esalen Institute, National Association of they said, ‘She has confidence in change a pan reaction to a reflective Social Work meetings, The Renfrew .’” response. Together they can heal the Center Foundation Conference, The International Association of Eating wounds underlying the eating Disorders Professionals, The New York We have all the theories, all the disorder and change the behavioral City Board of Education and numerous treatment approaches, all the tools to part which will in effect change the university campuses including Princeton share with our patients, a the thinking part and result in a holistic University and Barnard College. In reality is, it’s more about faith and transformation and healing. addition to a private practice, she runs belief. “I believe in possibilities,” clinical case focused supervision and Rabinor a “Anyone can change if Judith Ruskay Rabinor, PhD is a consultation groups for therapists and they are willing to do the work. Yet clinical psychologist, author, consultant other mental health practitioners. some people cannot take in love a and psychotherapist with offices in New support and connection from other York City and Lido Beach, Long Island people. They are too traumatized and She has more than three decades of too afraid being disappointed, experience working with individuals, couples, groups and families. Judy is Hanson, R. (2013). Hardwiring betrayed. A brownie will never frequently a keynote speaker and Happiness: The New of betray you, it will always be there.” workshop presenter at national and Contentment, Calm, and Confidence. Rabinor knows that it’s her job to international conferences, professional New NY: be there, to be present with her associations, retreat centers, universities

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Dare to Be You!

By Isabelle Tierney, MA, LMFT

"To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment." Emerson

Some time in the past . . .

I'm in the middle of a hot yoga class, bending, sweating, pushing my body, struggling to not pass out from the heat and my fight-or-flight breath. I feel awkward, big and not flexible enough. I feel like a loser.

I look around hoping to find someone who might sympathize with my pain. No such luck. All I see is a bevy of young, beautiful bodies who hold an amazing mix of strength, flexibility, and, most enviously of all, thinness.

In this moment, I truly wish I had a these perfect lives. Because being me good-enough, which means loveable- different body, a body like “theirs”. I is not good enough. Being me means enough. How much does “she” eat? want to effortlessly open my legs into I have this imperfect body. Being me How long can “she” hold that side- the splits, fly up into handstand, and means I struggle with an eating angle pose? How often does “she” sink into a perfect Warrior II. I want disorder. Being me means I will exercise? What is “she” wearing to be thin, flexible, and buff like these always believe that I’m a f**k-up no today? yogis because I assume that they matter how hard I try to be better. must be leading perfectly enlightened And then I try to do the exact same and connected lives. The Art of Comparison thing. Even if I’m so hungry and tired that my body wants to pass out. Even And while I know that this body of Over time, I learn the art of if every muscle is screaming for mine will probably never be able to comparison to try to move toward mercy. Even if my clothes look attain that kind of “perfection”, I do “perfection”. I leave my body and ridiculous on me. It doesn’t matter. not care. I will do whatever it takes to look outside of myself to learn how to I’m moving farther away from my push my body into these poses, into become thin-enough, which means not good-enough self and coming closer to the woman I want to be.

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The Art of Not-Listening

I also learn the art of not listening to myself. After all, if who you are is crap, why would you waste a precious minute focused on your body and your inner world? I don’t listen to my body’s needs. I don’t listen to my needs. I also don’t listen to the voice of my intuition, because there is no way that she could be trustworthy. And though I can see that I am a shell of my former self, I prefer to be an empty shell to the shameful, yucky, authentic me.

The Art of Non-Acceptance

Finally, I learn the art of radical non- acceptance. Day in and day out, I practice rejecting every single body part, thought, and emotion. If and Isabelle and her daughter, Sam, practicing the art of non-comparison when the fleeting possibility of liking something about myself arises -maybe because someone complimented me-, I make sure to stomp on it until nothing is left.

After all, the only way out of my unworthiness is through full obliteration. No kindness or compassion allowed.

Some time now . . .

My hot yoga class has just started, and the teacher is already pushing us towards a fast, difficult series of poses. My body is not ready for this. It’s just waking up, having spent all day sitting with clients. I slow myself down. I stop following the class’ pace and follow my own instead. Hello muscles! Hello bones! Hello heart! I love you! How are you in this moment? I’m here to connect with you and to see if you want to take a journey with me to move, flow, strengthen, and awaken together. Are you with me? Do you trust me? I promise to stay in full contact with you and trust YOUR rhythms and needs over anyone else’s. My body relaxes and opens like a flower, emitting a wave of love and pleasure that almost takes my breath away. We are ready.

I am so deeply grateful to be sharing this part of my journey with you. It took many years for me to realize that trying to be somebody else was exhausting, futile, and actually created the exact thing I was trying to get away from: feeling of unworthiness, disconnection, and pain!

It took the same amount of years to realize that trying to form my body into a shape that had nothing to do with me was fruitless as well. It only made me hate, abuse, and reject my body more. There was so much suffering.

The Art of Non-Comparison/Curiosity

In these last few years, I’ve learned the art of non-comparison. This art doesn’t just extend to not comparing myself to others, which kills all joy and all love. This art also extends to not comparing myself to me and my body, to who I was yesterday or 10 years ago, to who I think I should be tomorrow, or 10 years from now.

When I compare myself, I miss the extraordinary that is happening right now, which will never happen again in this exact same way.

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Because it’s hard to fully accept one’s self. And it’s hard to fully accept one’s body.

I am selfish, impatient, dorky, and narcissistic. AND I am wise and brilliant and funny and deeply connected to the spiritual world. My toes are insanely crooked. My spine is curved. My boobs are droopy. AND my face sags. My body has survived almost 30 years of an eating disorder and can still do yoga and dance and make love and eat Isabelle and her daughter, Sam, practicing radical acceptance. whatever foods I give it. THAT IS ONE AMAZING HUMAN BEING.

When I practice the art of non- held them for me, I now had to find Are you sick and tired of covering comparison, or said differently, the the courage to feel them again, and yourself up with masks and defenses, art of absolute curiosity, I get to even possibly love them for the first of wrestling your body into a size and know and explore the brilliant time. shape that has little to do with who it creativity of Creation that lives in me longs to be? Are you ready to trust and in my body. I become like a baby What I didn’t know was that that being yourself is the only way to who first notices her hands and her coming back into my body and be truly free? feet. Have you seen how fascinated practicing listening also meant that I she is with her toes?! discovered my body’s brilliance, my I declare my commitment to being intuition, the crazy-ass deep, infinite exactly who I am, the sacred, the This makes me want to ask: Who is love that lives at the very core of me. messy, and everything in between. my body? MY body, not my 20-year- I'm not promising it will be easy. I old body, not yours, not the I love the words “active listening.” still sometimes would rather to hide supermodel’s or the movie star’s. I Like absolute curiosity, active in a corner than accept my body or also become passionately curious listening requires engagement, myself as is. This re-owning process about who I am. Not Oprah, or presence, a focusing on what is is scarier than anything I've ever Mother Theresa, or my neighbor. Me. happening now, and now, and now. done. And more exciting and In this moment. Now. There is no way for me to know astounding as well. when I will be hungry, what I will The Art of Active Listening want to eat tonight, whether I will But if I don't do it, who will? And want to do yoga, rest, or go to the if you don't do it, what will your In these last few years, I’ve also gym tomorrow. It is not possible for default life look like? learned the art of active listening. me to know when I will die, what Are you with me? This has required me to come back next year will bring, or what the into my body after years of world will look like in 20 years. My abandonment. You see, there is no only job is to listen to what is Isabelle Tierney, M.A., LMFT is way for me to practice listening to happening in this moment and take coach, author, speaker, and therapist with my body or myself if I am not there, loving action if necessary. No more. if my consciousness has been looking No less. an international following. She is outside of itself for guidance about passionate about teaching us to “Dare to who to be. The Art of Radical Acceptance Be Real! The Sacred and Messy Art of Being Human” through her podcast, her This has not been easy. There was a My last and hardest practice in the writing and her practice. She is also an perfectly good reason I left my body! last few years has been that of radical expert on eating disorders and other I had done a brilliant job leaving the acceptance. This practice could painful habits and addictions. She is a old traumas, the pain, the shame, the only occur after I stopped comparing published writer and national presenter. hate, and the rejection behind. And myself to others and listened to my Most of all, she loves being a fully while my cells lovingly and patiently truth instead. embodied human.

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Freedom

An Interview with Diane Israel, PhD

By Nancy Eichhorn, PhD

“I had become the ultimate athletic machine. My life was about trophies, performance, what others thought. I externally identified my self-worth. I had abandoned myself.”

Diane Israel was a world-class My illness was a loud wake-up call to Highly Sensitive People triathlete. She trained for the stop abandoning my feminine. To Olympics under the adage, “no pain, stop avoiding my emotions and Eating disorders are a brilliant life no gain.” She pushed, hard. She ran myself.” saving device. Food is a self-soother, on shin splints, tendon strains, torn a distraction, a means to cope with ligaments. Her motivation to excel Israel shares her story, not to stay unmanageable situations, feelings, fueled in part by her need to achieve mired in the past but to move forward experiences. Looking at her own and her need to fit in, to find her and help others challenged with behavioral choices and those of her place, her acceptance, her value in addictions, be it exercise, food, clients over the last 30 years, Israel this world. Everything became about alcohol, relationships, sex, shopping, found a common theme with clients winning until it ended. and so on, come into their own place who struggle with eating disorders— of wholeness and self-acceptance. they are born into this world highly “I was 28 years old when I got sick She explains that her constant tuned in. They are highly sensitive (chronic fatigue syndrome),” says movement, a form of exercise people born into families without Israel, a psychotherapist in private bulimia, was an unconscious language, tools, or comfort around practice in Boulder, CO, a professor adaptation to turn off the intense emotions. of transpersonal psychology at overwhelm she felt. “I felt like a Naropa University, and producer of weirdo, left out, odd. I didn't fit in Citing the work of Ane Axford, the award winning feature length anywhere. I was afraid and anxious LMFT, Israel explains that people documentary, Beauty Mark. “I about life. I ended up turning my with addictive behaviors often share discovered I could no longer abandon focus inward on what I would or the same neural trait related to a more my body. I could no longer live this wouldn't eat to control and punish sensitive nervous system that affects lie. I had to begin to honor the myself,” Israel says, all the while our lives. Highly sensitive people feminine, the ruler of the body and training beyond healthy physical (HSP), a term coined by Dr. Elaine embodiment. If we try to become boundaries, beyond the meager Aron, author of The Highly Sensitive machines, if we deny our bodies and nutrients she ingested that rarely met Person, are genetically predisposed kill of our feminine, we become sick. her body’s needs. with nervous systems that pick up

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vibrations, sensations, and support them in handling them. I emotions including hate, anger, stimulation more readily than other coach them in being able to be with shame, envy, sadness, and suicidal people. Their sensory processing all that they are,” Israel says. ideation. The remaining seven cards system (SPS) is more attuned and teach empathic mindfulness skills processes bodily experiences more Embodiment supporting emotional and empathic deeply. Their SPS is sensitive to awareness. "Each card has questions sensory and emotional stimulation Part of Israel’s work involves about what triggers the emotion, and overstimulation. According to awareness, helping clients sense their question to ask yourself when the Axford’s website, 20% of the sensations, sitting with the bodily emotion arises which aid reflective population are HSP; they tend to experiences, sitting with acceptance explorations, such as 'what's about develop autoimmune disorders such not judgment. This process is often this emotion is beneficial?' 'what gifts as celiac disease and chronic fatigue labeled embodiment, being embodied does this emotion bring?' 'what needs syndrome, anxiety diseases, and or mindful. protection?' There are no wrong or struggle with addictions (food, bad emotions, all have value and alcohol, relationships). HSPs often Israel says “embodiment is offer information. For example, anger develop gifts that benefit others learning to be with ourselves even if reveals there's a boundary issue being based on sensitivity; for example, all our sensitivity buttons are pushed. triggered. A suicidal urge often highly developed empathy, We can stay with our self and means something is dying to change, compassion, and intuition. embrace our own experience. something needs to be transformed, Embodiment is not stagnate. It is reborn. I use these cards daily with Axford offers an online video to active, flowing. It changes every clients. I work with the cards because teach people about HSP. Israel gives moment. You have to go with it. we are not taught how to deal with Axford’s manifesto to clients to, in Embodiment is an intimate rapport our feelings our emotions in this turn, pass on to their friends, family, with your life pulse. I feel that it’s culture. The source/root of addiction colleagues to see if they can handle hard to be an authentic human being is not being able to embody the them in the truth of their inner light. in this culture. Most people don’t enormity of what we feel; instead The work is about reframing the know how to do it; it takes getting off when we feel shame, envy, etc. we internalized message from “You’re the doing wheel.” drink, binge eat and throw up,” Israel too sensitive,” to “I’m sensitive, too”. says. It’s a shift from “what’s wrong with “When we learn how to deal with me”, to “I belong as a highly our emotions it’s like being in the “McLaren talks about the beauty sensitive person, and I work in a ocean riding waves.” of our raw emotions like fear, totally different way that’s just as jealousy, and anger,” Israel adds. important” (retrieved from http:// Israel started working with Karla “They are actually a beautiful sensitiveandthriving.com). McLaren and a tool McLaren created experience before we layer on our called the Language of Emotion story. We need to be aware and learn “I help people move through their Cards. They were designed to help to feel our raw emotions. Be able to obsession with food (it could be people increase their emotional say to ourselves, ‘Oh this is just some drugs, alcohol, sex, washing hands, awareness and their empathic skills. heat, it will give me energy, the shopping) to support them in the There are twenty-four cards, impulse to do something.’ Be with enormity of what they are feeling and seventeen offer insight into different the raw beauty of the raw emotion.

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I now view my anxiety as my workable no matter how messy. of our being, be it our biological aliveness. It’s this intense energy. My Every neurosis we have is brilliant—I family or one we create. Finding a anxiety is there a lot. Last year my wouldn’t be here if I hadn’t found my therapist who has lived through an teacher, Bruce Tift, told me 'be with it M.O. (modus operandi) to cope. As eating disorder (or addiction), who and so what' Getting ready for it is we age, we have an opportunity to knows it intimately is one part of the the opposite of expecting it, counting heal our defense mechanisms we family support; it’s crucial to know on it, getting rid of it. And if it’s not created as young children when we that you are not alone. there, it’s a reprieve.” didn’t have the skills to deal with our emotional enormity.” “I’ve lived it,” Israel says. “It takes Happiness versus Freedom one to know one. I can look my “I see women in their 40s and 50s clients in the eye, and they know I “We can’t do it alone,” Israel says. with eating disorders that don’t serve really get it. I have no regrets. Our “I don’t want my clients to come in them anymore. When you are 50 experiences make us extraordinary and talk only about their stories. I do my best to meet people where they “I’m not into happiness, I’m into freedom. Happiness is a are. I don’t spend a lot of time in the energy on the story. The state of the temporary emotion. Freedom is what we talk about when brain—our reptilian brain will do we talk about embodiment—learning to be with what it does, it will go to fear, everything. If you are feeling depressed or anxious, you negative emotion, etc. I trust the instinctual process. I see humanity as are not happy. But, if all emotions are real and you can be extraordinary human beings. with them, then we can be free to experience freedom.

The ability to hold the enormity of our emotions, is where “I’m not into happiness, I’m into freedom” she continues. “Happiness freedom is, and happiness often comes with freedom.” is a temporary emotion. Freedom is what we talk about when we talk about embodiment—learning to be years old, we have an opportunity to people. I get through my addiction with everything. If you are feeling heal the patterns we developed to with passion, compassion, and loving depressed or anxious, you are not survive. Bringing awareness to your kindness. I let my clients know that happy. But, if all emotions are real eating disorder is a tremendous and they are are not flawed. That their and you can be with them, then we beneficial healing component. The addiction is part of their journey in can experience freedom. The ability first 30 years, I was not aware why I healing.” to hold the enormity of our emotions was starving myself; developing is where freedom is, and happiness awareness was a component of my Service is huge as well, Israel says, often comes with freedom. healing process.” knowing that we have a purpose, Ultimately, to experience freedom of something to give of ourselves to being, I have to honor my needs. Four Themes others. But to offer our best, we have Then live it, embody it, practice it.” to value ourselves, know we count. There are four themes Israel also Israel offers the idea of ‘self-ing’ The Fruitional Model addresses with clients to support their because the word selfish has negative health and wellness (family, connotations. “It’s healthy to be “With the help and support of my community, service, and identity). selfish through ‘self-ing and that’s the teacher, I practice the Fruitional Diane also appreciates Maslow’s idea of intimate rapport with our model in my work. I’m not a hierarchy of basic needs: food, self,” Israel says. “And within ‘self- Buddhist yet Buddhist principles shelter, sleep, comfort, family and ing’ there comes a sense of identity: make so much sense to me. The community. She supports clients to Who am I? I have to live a life that Fruitional model reflects the work on sleep patterns, how to find allows time for meditation, healthy wholeness of the human being, and I their own rhythm of what works eating, being in nature. These are work with clients to restore their around food, how to notice what’s requirements for me. I can get away remembering of their wholeness. I happening in their environment, and without them for a short bit, but my ignite and shine a light on the if things are distorted how to life doesn’t feel as vibrant,” Israel complexity of our humanness, our maintain a sane state of mind. says. “I live for nature, stillness, and behaviors, our stories. In the Western the gift of being in a body.” model of medicine, we need to be According to Israel, we all need a fixed. In truth, we have nothing to get healthy family, a tribe to belong to rid of, nothing is thrown out. Life is where we are accepted in the fullness Continued on page 110

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Beauty

Mark

A Film by Diane Israel, Carla Precht, and Kathleen Man Reviewed by Nancy Eichhorn. PhD

Diane Israel has a story to tell. Deep. Intense. Revealing. Personal. Powerful.

Woven within her experiences with anorexia and exercise bulimia are tales of abandonment, distorted thinking, depression, chronic fatigue, disfigurement, anabolic addiction, fear, rape, sibling rivalry, inadequacy, insanity, family pressures, and self-hatred. These are not all Diane’s storylines, however. In this masterful documentary, Diane and her co-producers, Carla Precht and Kathleen Man, weave in other peoples’ stories as they document Diane’s childhood immersion into exercise abuse and starvation, her physical breakdown as her body simply stopped and left her bedridden for months, and her transformation as she sought a new definition of beauty.

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begins with Racing Diane shares her life in intimate Her Heart Out—the detail. There are family videos, news story of how Diane clippings, interviews with her cousins became an athlete and her former partner. And she and how she allows other people to share their stopped eating and experiences as well. eventually landed in bed with chronic Cindi Andrews and her son, Zach, fatigue. Next they were severely burned in a fire that develop the almost killed them. Cindi shares that concepts within before the fire she had it all—the Distorted Mindset perfect life—but she felt empty Diane Israel. Photo courtesy Media Education Foundation and Mayhem inside. Her experience after the fire dealing with family taught her that material possessions Diane stopped eating at age 12 as her fractures, and eating and exercise and external beauty do not create obsession to run and win increased. disorders. Searching for Beauty, Re- happiness. When she was 8 years old and her imagining Beauty, and finally, Going brother, Rob, was 6, their father Home round out the film’s contents. Dave Scott, a six time Ironman, timed them while running. Seems shares his view of Diane while she Diane lost, which really “pissed her There are free materials on The was racing, and he shares his story off”. She trained hard and was soon Media Education Foundation © about his decline into exercise a winner. She burned-out on running website (www.mediaed.org) bulimia and insufficient nutritional and became an award winning including a study guide by Jason care. Rick Jones talks about his move triathlete. She might have been a Young to assist teachers/coaches, from being a skinny runt kid to a worldclass athlete, but she didn’t group facilitators, and therapists— ripped world class body builder with nourish her body—she says she anyone in an educational setting the aid of steroids and his recovery “trashed” her body, which ended her support a learning experience. The from anabolic addiction. career. She explains her need to guide includes key points made in the control her exercise and her food was film, questions to guide discussions, Diane shares personal stories as well her sanity, her way of coping with a and extension projects. It was created as professional conversations with childhood comprised of confusion to help viewers “slow down and influential therapists and authors in and contradiction. At home, extreme deepen their thinking about the the field including: Jane Body, polarities were the norm. specific issues” addressed in the film. Naomi Wolf, Eve Ensler, Paul They also structured the guide so Campos, and Ellen Hart Peña. All At age 28, love catapulted Diane users have the option of “focusing in add their take on beauty—what headlong into fasciation and depth on one section of the video at a defines it, who defines it, and how obsession as she felt internalized time” and “stay close to the video’s we live with it. There’s even an stirrings of femininity, sensuality, main line of argument as it unfolds.” interview with a mannequin and sexuality. From this place of manufacturer who discusses his growth, she was determined to share her life helping women faced with similar struggles with body images. In her forties she went to New York determined to produce an educational film to encourage awareness and conversation—to get men and women dialoguing about their own self-abuse and start on a healing path. There is no definitive finish line, Diane says in respect to healing and her own sense of being done. It’s a process, an evolution, and the finish line is the gift of life.

The film (51 minute viewing time) is divided into chapters, each related to a segment of Diane’s recovery. It Rick Jones during his prime body builder phase. Photo courtesy of MEF

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damage and eventually placed in a home, was present. Diane interviews her parents, and a poignant moment occurs when Diane asks her mother about beauty and she replies that it comes from the inside and outside of a person—it takes both, she says.

The film is well done and worth watching whether for the personal viewing experience or to preview for use with clients, students, community Courtesy Media Education Foundation members and so forth.

mission to create models with more realistic figures.

The ending of the movie offers an unexpected twist that brings an emotional zing to the chapter entitled, Going Home. Diane goes to her mother’s house in New York for a family gathering—her parents divorced some time ago but her father stays connected, especially since her mother’s stroke. Her younger brother comes with his new baby and wife, and Diane’s older brother, who was born with brain Sexualized beauty. Photo courtesy The Media Education Foundation

The always win. Girls are taught to stay gives exercises and tools to readers to Woman in quiet which influences their adult challenge what they have been taught the Mirror: sense of low self and body esteem and to learn how to chip away the How to Stop little voice in their head that never Confusing Dr. Bulik’s goal in writing The stops criticizing. Dr. Bulik includes What Woman in the Mirror: How to Stop case studies and examples to help You Look Confusing What You Look Like With readers understand that almost every woman in the world experiences the Like With Who You Are is to teach women how Who You to separate self-esteem from body- same things her readers do. Are. esteem. Self-esteem is how we feel about ourselves as a whole; body Every chapter begins with a quote esteem, a small part of self-esteem, is for readers to find inspiration from or how we feel about our physical sympathy with. “I am a woman, hear Written by Cynthia Bulik appearance. Many women feel me roar,” from Helen Reddy’s song, discouraged, put down, and silenced, I am Woman, is one quote that is Reviewed by: Nataliya Rubinchik but instead of changing who they are used to introduce a chapter. and being heard, they change how they look. This book is clear and easy-to- Many women spend their lives follow. Dr Bulik combined her fighting against what they see in the The book is divided into two parts. experiences of being a woman, a mirror and are rarely satisfied. Young The first part talks about how women psychologist, and a mother in such a girls are often taught that they are the are taught to feel about themselves way that all her knowledge can be weaker gender and that boys should from “elementary school to the used to help improve the self-esteem nursing home”, and the second part and body esteem of all women.

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Please direct all inquires to Pilar Llobregat at [email protected].

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a list of attributes for each category on how to eat mindfully around that allows readers to figure out what others, especially during the holidays. type of mindless eater they are. The fourth part is about the Albers believes that everyone is mindfulness of the thoughts. Albers guilty of mindless eating at some discusses the dangers of “mindless point, and she emphasizes that thinking” that includes progress is more significant than overgeneralizing an outcome, perfection. It is more important to overstating things or ignoring control the present moment than it is significant information (p. 202). She to focus on the past or future. In a recommends planning meals in order time when many people have busy, to avoid emotional eating. Albers fast-paced lives, often eating meals also explores the idea of the “inner while they work, this book reminds food critic” and how to silence the us of the importance of slowing down voice that shouts judgmental remarks and using our senses to actually enjoy at you about your food choices (p. Eating Mindfully: How to End meals. 219). Mindless Eating and Enjoy a Balanced Relationship with Food. The rest of the book is divided into The fifth part is new to this edition five parts. The first part is about the and serves as a review. It consists of Written by Susan Albers, PsyD mindfulness of the mind. This a detailed checklist with all of the involves being present and aware of tips for mindful eating that Albers Reviewed by: Mona Zohny all five senses when one eats. Albers covers throughout the book. The points out that doing so will allow author also provides several different In Buddhism, mindfulness is one of one to feel more pleasure while scenarios emotional eaters can find the factors of enlightenment. eating and be able to stay in control. themselves in and ways to handle the Recently, positive psychologists have She also discusses the idea of letting situation mindfully. begun to explore this concept in the go of food restrictions and context of physical and mental categorizing foods as being good or Every chapter of this book health. Albers’s second edition of bad. provides readers with exercises called Eating Mindfully is structured the skill builders that keep them engaged. same as the first and builds on The second part is about the Some of these skill builders require information previously provided. mindfulness of the body. This means the reader to keep a food diary. The book’s purpose, however, goes paying attention to the signs of Others simply require a mental task. beyond helping people with eating hunger in order to distinguish Albers recommends reading the disorders—it contains dozens of tips between emotional and physical whole book before starting these to address mindless eating habits by hunger. It also involves paying exercises. She provides many increasing mindful thinking and attention to one’s physical motions different types of skill builders so mindful behaviors. while eating. The author explores self there is something for everybody. -acceptance of one’s past, present, Mindfulness is described as being and future bodies. Albers Eating Mindfully: How to End present and aware from moment to recommends meditation and Mindless Eating and Enjoy a moment. Eating mindfully involves breathing exercises to train oneself to Balanced Relationship with Food is being aware of the taste and texture remain in the moment. She also a comprehensive and engaging guide of food, the physical process of explores the idea of fine tuning one’s to eating mindfully. It can be used by eating, the physical sensations of taste buds. almost anyone who wants to learn hunger and fullness, and the emotions how to be more present and aware in involved. The book starts off by The third part discusses the their eating habits and daily lives in answering common questions about mindfulness of the feelings. This general. This book focuses on the mindful eating. Albers also provides involves figuring out the emotional readers and their experiences, while a summary of the five types of triggers that cause mindless eating as Albers also provides relatable mindless eaters: the occasional well as dealing with negative feelings examples from her own clients. The mindless eater (new to the second regarding one’s weight. It also skill builders provided allow the edition), the chronic mindless dieter, encourages readers to think about reader to apply the concepts the mindless overeater, and the how relationships can affect their discussed to their lives. mindless chaotic eater. She provides eating habits and even provides tips

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Body Awareness as Key to Detecting Predators and Advancing Eating Disorder Recovery

By Joanna Poppink, MFT

“In order to effectively avoid and respond to predation, animals must first identify the presence of a potential predator."

A healthy and aware woman notices threatening and This belief only makes her more vulnerable to the dangerous signals from people or within environments. exploitation. Her stomach lurches in disgust or her throat muscles gag slightly at an unsavory invitation. If she is offered gifts or Like all biological organisms, her body registers praise from a stranger, she becomes suspicious if she feels negative influences preying on her well-being. However, the hairs on the back of her neck rise. When asked to she remains mentally unaware because her eating disorder support a project with her energy and money but with no is in place to maintain a separation between body and reciprocity, she is likely to feel a slight chill down her mind. She believes that her trembling, muscular readiness spine and pass. Walking down a city street and seeing a to bolt, chest tightness, headache, and pounding heart are dark alley, she is likely to feel a sudden sick feeling in her symptoms of her fear of psychotherapy and life without gut and cross the street. If her car makes a strange sound, her eating disorder. her body tenses. She will have a mechanic look at the engine. These first meetings are critical. I rely on my own body awareness and mindfulness practices to keep me In more than 30 years of working with women with centered and present. I need to be with her as she is. eating disorders, I see a common physical thread. My patients dull their awareness of body warning signals and At the same time, I've learned that before me sits a experience them as eating disorder triggers. In the past woman who, if she stays in psychotherapy, is about to decade I've been using a predatory/prey model as a guide take a surprising journey that will both obliterate her to help my patients and I identify self-protective mental oblivion and show her not only the life she is information that comes from the body as both wisdom actually living but also that various actions she can take and a vital aspect of eating disorder recovery work. will greatly improve her life. I see her courage.

A new eating disorder patient in my practice often In my experience, women with eating disorders are arrives with a current or past stalker in her life. It is not highly intelligent and creative. Once they erode or breach uncommon for her to have at least one or more exploiters the barrier between mind and body, they can use their in her personal life or at her job who drain her physical, bodily responses as information to guide them in self- emotional, and financial resources with little or no benefit protective actions. They can shed their eating disorders to her. She may be angry or resentful, but often she is like outgrown shells. docile or proud in her acceptance of this treatment. She It's a paradox that a woman with an eating disorder believes she is noble, generous, and kind as she helps and can obsess about the size, weight, and shape of her body, supports her exploiter.

Opening quote by Renee L. Rosier & Tracy Langkilde

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exercise and eat, and yet remain time, she did more exercises and so miserable because of her weight oblivious to many physical learned to tolerate her sensations that he couldn't rally his potential and experiences. My challenge is to rather than eat bags of candy in bed earn more money. introduce body awareness exercises at night alone. Her conversations knowing that, initially, my patients with her husband, now based on the She had trouble identifying may resist because being aware of reality of times, dates, places, and physical sensations during a body themselves in the present moment is money must have been threatening to scan. Attending to her breath, exactly the experiential state they him. They disrupted the predator/ however, had the effect of making strive to avoid. prey balance that relied on the prey's her more aware of her environment. lack of awareness and emotional She trusted her husband, but our Body awareness exercises such as rationalizations. conversations brought up behavior I body scans, mindfulness practices, wondered about and questioned. He breathing exercises, and meditative He stayed away longer but still spent many hours on the computer in walking are pathways to help them called with loving words daily. his private studio. When she asked awaken to their own genuine Eventually he came home and why, he told her to "take her big fat experience. They resist because even abruptly told her of his current affair nose out of his business.” In the past approaching consciousness of the with a woman he planned to live with his response would have sent her into present moment brings up a sense of immediately. He confessed to a long a silent place of shame and despair. imminent catastrophe. history of extra marital affairs, and This time, while she staggered under his desire to kill her after he made her the familiar assault, her mind stayed I've learned to respect how leave the business. She was horrified clear. precarious and vulnerable my patient and grief stricken at the sudden feels when I introduce body collapse of her fantasy and the She told me she felt guilty but went awareness practices. In Healing Y our emergence of who this man was. into his computer when he was away. Hungry Heart, I describe how to do She discovered pornography and e- these practices. But in the clinical Body awareness helped her reveal mail correspondence between him setting the practices are introduced the reality of her life and exposed her and sexual partners. She was informally, almost casually as part of predator. She was an intelligent and heartbroken, confused, and angry. our conversation. creative woman. Despite her anguish, Over the next few weeks she went she drastically limited her eating through drawers of documents and For example, Susan, suffering from disorder behaviors. She legally tapes and discovered that he Binge Eating Disorder, complained separated from husband, took care of gambled, had huge debts, paid for sex of loneliness because her caring herself financially, and started a new with overweight women, and despite husband spent much of the year out life elsewhere. While she suffered what he had told her, didn't have a of town as he attempted to sell their emotionally, the revelations of her job at all. business so they could retire together reality freed her body from the stress in style. of suppressing her awareness of the Body scans became a regular part exploitation. She had more energy of her daily routine as she processed When I asked her to describe what available to care for herself. the reality of the life she was living. was happening in her body, she didn't As she relied less on bingeing and understand my question. I did a brief Recovery is more complex than purging to mask her situation and body scan with her, starting at the top detecting predators and moving into more on reading her body sensations, of her head where I was certain she realistic self-care mode, but predator she was no longer blind to how she felt no stress. As we moved through detection is essential for the entire was being used. to her jaw, neck, and shoulders, she recovery path to unfold. Susan is on described the rigidity I could see but her way. Once she was willing to detect her which she was unaware of before the predator, she extricated herself from him and was more mindful in other scan. Melinda, suffering from bulimia, lived with her husband of 19 years. relationships. Happily, she As I invited her to watch her He criticized her for being discovered that she was sexually breath. We moved to her chest and overweight and said he could not kiss desirable while she built a new life diaphragm. She burst into angry her or make love to her because he for herself. tears. "I'm alone, so lonely. I built found her body disgusting. She had a the business with him and now I'm high power, high income job and I describe breathing mindfulness shut out. No one tells me anything. paid for almost all the home expenses exercises in Healing Y our Hungry I'm so tired of waiting for him." including house, car, and vacations. Heart to people I don't personally She was shocked at herself. Over She said he had a gifted mind but was treat. In my practice, I tailor these

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exercises to the individual. My hope protective action. Each aspect of their deficits is an ongoing part of her is that readers tailor the exercises to awareness carries information. When recovery psychotherapy. fit their own situations. they have full access to all three aspects and respect them, they can Humans are still prey to other I invite my patients to come ten coordinate information about their humans in this dangerous world. But minutes early to their appointment, situation and make wise choices when the eating disordered woman find an appealing place in the garden about how to respond. surrenders her eating destructive and watch a plant of their choice. I behavior to increasing awareness of tell them to pay attention to color, This way of living gives women reality she can detect predators and shape, movement, and any insect or solid evidence that their reality-based find effective ways to elude them. animal life that may enter the picture decisions are far more powerful and She is no longer a victim. She can and while doing this to watch their protective than self-destructive eating come out of hiding, use her resources breath and be attentive to body disorder behavior. They begin to live for herself, and flourish. Her body sensations. in a way that continually reinforces becomes her friend as she allows her recovery. normal, genuine, biological responses For patients who live at the beach, to help guide her through her days. I suggest they sit on their balcony in The ongoing challenge for many of the morning and watch the ocean. I my patients is learning the difference Joanna Poppink is a private practice invite them to be aware of sensations between reality and fantasy. The licensed psychotherapist in Los Angeles, California since 1980 and author in their body as they observe the body knows the difference. of Healing Your Hungry Heart: rolling waves, paying particular Whenever a patient is in doubt about Recovering from Your Eating Disorder. attention to exactly where a wave her perceptions, whenever she is She supports creative and healthy breaks. being self-critical or feeling shamed development in all phases of a woman's or worthless, she can check in with life, honoring her authentic mental, For patients who “have no time” her body to see if she is ignoring emotional, and spiritual yearnings as she for mindfulness practices, I suggest danger signals. If she ignores them, moves from living with an eating they walk for ten minutes paying she opens herself to a predator in her disorder into freedom and health. In her attention to their body, emotions, and life. book, Healing Your Hungry Heart, she thoughts. I ask them to be curious gives frank descriptions of secret, emotional, and personal, challenges and make a distinction, if they can, The predator targets her as prey when living with an eating disorder and how to use them as opportunities for healing. Using stories from her personal struggles with bulimia along with stories from a wide range of women she has known, Joanna offers hope, inspiration, and specific healing practices. She writes to adult women in their 30s, 40s, 50s and beyond. Her website, http:// www.eatingdisorderrecovery.com, is a vast and free resource where visitors are invited to comment, ask questions and participate in ongoing recovery forums. Email: [email protected]

References

Damasio, A. (1999). The feeling of what happens: body and emotion in the because he recognizes her making of consciousness. Boston: between a physical sensation, a Harcourt Brace. feeling, or a thought. vulnerability. The strength of her Hanh, T. N. (1993). The present moment. reliance and belief in the predator's Audio CD, Boulder: Sounds True. Body exercises help women tolerate lies is based on her own Kabat-Zinn, J. (2005). Full catastrophic their feelings without escaping into developmental deficits and how living. New York: Bantam, Dell. Kornfield, J. (1993). The inner art of their eating disorder. They learn that much she needs his promises and meditation. Audio CD. Boulder: Sounds they can experience body sensations, declarations to sustain a sense of True. have emotions, and think at the same what she understands as wellbeing. time. This is vital for detecting a Addressing these developmental predator and taking wise self- Continued on the bottom of page 108

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Healing Your Hungry Heart

Written by Joanna Poppink, MFT

Reviewed by Nancy Eichhorn, PhD

As a child, my family’s discussions often centered on the value of thin versus fat; my father even cited research studies to substantiate that thin rats outlived fat rats. Thus, the logical decision to stay the course, be it Weight Watchers, Atkins, Slimfast, the grapefruit diet, whatever trendy diet was in vogue at the time to achieve the almighty status of thin. Weight and the subsequent attachment to body image were critical factors in my life, not for health reasons but for beauty and self-worth. Thin people were in, fat people were out. Yet, binge eating was a way of life in my family. I learned that food soothed, silenced, sequestered my emotional overwhelm then sentenced my feelings to the inner darkness of my belly. I didn’t have the skills to cope with life. Over the years, my weight came and went.

I started reading self-help books in my mid-twenties, about the same time I weighed 90 pounds or so on a 5’ 5” skeletal frame. I recall my father getting rather furious one day while we were canoeing—he sat behind me counting my ribs as they protruded from my emaciated back. Starvation transitioned to binging and purging, to a 30 year relationship with disordered eating behaviors. I remember falling in love with Geneen Roth, Natalie Goldberg, and Anne Lamott; their first person approach to addiction and healing called to me. Yet, as always, nothing moved me to lasting change. Band-Aids. Stop gaps to address deeper concerns fueling the war with my body and the disconnect from my being, the grief and sorrow surrounding my soul and her desire to leave this life in any way, shape, or form.

Reading Joanna’s book, Healing Y our Hungry Heart, what was never instructed, to support what was never I felt a resonance with both the beginnings of my validated and loved. dysfunctional eating behaviors and the path I followed toward a healthier relationship with my body and with my She offers many strategies that are common place in self—the core consciousness I consider ‘me’ rather than eating disorder treatments—journaling, joining groups to the muscle, fascia, fluid, and boney frame that houses my avoid isolation, creating daily rituals, and repeating energetic being. affirmations to stimulate cognitive and behavioral change. What sets this book apart from other self-help books for For starters, Joanna shares her life with bulimia. She me is her engagement with the body and specific openly writes about her move into this destructive place strategies to approach a relationship with what for most of being and her struggle to transition away from its grasp folks living with an eating disorder represents the battle into a loving place of self-acceptance. Her story is ground, the war zone, the heart of the intensity and familiar in many ways, not the precise details, but the destruction. Joanna offers descriptions of what you may undermining feelings that collapse our faulty, if at all feel in your body such as, “a slight nervous sensation just present, self-coping strategies to deal with what life brings below your shoulders in your upper arms, a leaden feeling our way. When it comes to therapists claiming to be in your abdomen, a prickling behind your forehead and a eating disorder specialists, I believe it takes one to know slight throbbing behind your eyes, a quivering in your one. Joanna knows. And her journey, within the pages of upper thighs”—all these sensations, she says, can send her book, offers a gentle step-by-step guide with strategies you to food (p. 95). She teaches readers how to do body and skills to replace what was never nurtured, to teach scans and builds a platform for mindfulness practices with

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daily reflections and breath work— She writes that to heal “you create and mature in order to “deal with there’s time and practice to befriend the opportunity and conditions for what reality brings to you. You stay your body and discover pleasurable your heart and soul, your body and conscious. You stay present. You body sensations, which are also mind, to heal and grow beyond your gather your resources and expand blocked when so called negative present limitations” (p. 164). Every them to cope well and live” (p. 154). feelings are shunned. One exercise exercise in the book is designed to asks you to be present to your help you be more reflective, to see There is a wealth of information as feelings in the moment and as you your inner worth through self- well in the appendices: affirmations; pay attention to what you are honesty and explore your own true journal prompts; facts about eating experiencing, she asks, “What part of disorders and treatment options; your experience is thinking? What additional exercises and activities; part of your experience is emotion? P. A. M. : Pause a Minute recommended reading/CD/DVD list What part of your experience is including fiction, spiritual, fairy tales physical?” (p. 129). and legends, human development, When you find yourself in the consciousness, memoir, and poetry; process of overeating—at a meal, Two exercises stood out for me. websites for support and study. sitting at your computer, watching The first is entitled, P.A.M.: Pause a television, pause, take a deep Minute to stop overeating. When you I know there are a slew of self-help breath, and close your eyes. Pay find yourself in the process of books on store shelves, Amazon, attention to your breath. Don’t overeating—at a meal, sitting at your Kindle, and more, and we all need to change it. Simply watch it. Feel the computer, watching television, she find what works best for us. There’s a oxygen enter your lungs and recommends you pause, take a deep resonance and when you find the nourish your body. Tell yourself breath, and close your eyes. Pay right guide, you give it a try. Healing there is plenty of food in the world. attention to your breath. Don’t Your Hungry Heart resonated with You can have more at your next change it. Simply watch it. “Feel the me, and I highly recommend it for meal. Commit to what time you oxygen enter your lungs and nourish people living with eating challenges will eat a nourishing meal again. your body. Tell yourself there is as well as for psychotherapists and Tell yourself you will be to plenty of food in the world. You can health care workers (doctors, nurses, yourself during the time between have more at your next meal. Imagine nutritionists, dieticians and so forth) meals, and you will give yourself a your next meal. Commit to what time who support patients struggling with good next meal. you will eat a nourishing meal again. disordered eating behaviors. Joanna’s Tell yourself you will be kind to website: http:// yourself during the time between eatingdisorderrecovery.com/ offers meals, and you will give yourself a nature as you offer yourself excerpts of the book and exercises. good next meal” (retrieved from compassion and appreciation for our You will also find blogs, forums, http://eatingdisorderrecovery.com/). imperfections as we live in an articles, and contact information. imperfect world. “Living a life According to Joanna, “As you without an eating disorder means Recovery is fluid, flexible, infinite, practice P.A.M. on a regular basis living at a deeper level where you and learning new mindfulness you develop the ability to break your perceive more in the world, in other practices is always a welcome overeating pattern. You learn to trust people, and in yourself” (pg. 203). addition to my current skill set. I’m that you can bear your feelings. You jibing more these days and laughing earn your trust by supplying yourself The second exercise that spoke to at my attempts to do things from a with nourishing and tasty meals on a me is what she calls, “jibing”, a different perspective, loving myself regular basis. When you trust that sailing term used when the boom as I falter and as I succeed. I read the you will care for yourself and tend to shifts fast and hard from side to side book in two sittings, actually, taking your needs, you don't need to overeat of the boat forcing the boat to notes for the review and for myself, because you want to ward off suddenly change direction. The idea noting pages to return to for further deprivation. You know that you will is to shake things up, to “startle your reflection and to share with those provide yourself with enough. Do mind, emotions, and body in a simple who come to my door looking for you trust yourself to give yourself the non-threatening way to learn how to acceptance and support. I truly nourishment you need? How can you focus on being present” (p.105). As appreciated Joanna’s candor and her develop even more trust in your mind, body and spirit become willingness to be present on the pages yourself?” (retrieved from http:// more flexible, Joanna says we will of her book and in her work with eatingdisorderrecovery.com/). become more confident in new people living with eating and body situations, more resilient, creative, image challenges.

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IBPJ continued from page 9

Submitted manuscripts should follow the academic conventions of the IBPJ, e.g., referencing styles, and publishing guidelines for submitting research articles. Visit the IBPJ website for details on Authors’ Guidelines: www.ibpj.org/authors.php.

Both qualitative and quantitative studies that involve the body in psychotherapy are welcomed. The paper must not exceed 6,000 words (not including abstract, references, figures, tables, etc). An abstract of no more than 200 words should accompany your submission, along with five keywords. Author Guidelines must be closely followed in order to be considered for publication.

Submissions should be made in an attachment to Editor-in Chief: Jacqueline A. Carleton, PhD at: [email protected] with “Research Issue” in the subject line.

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International Connections

By Asaf Rolef Ben-Shahar

Eating Disordered Relationships

Pondering on the eating disordered therapeutic dyad – enactments, ruptures, and repair

As long as mum is unhappy Elaborating on this hypothesis and clinically exemplifying “I would rather be miserable than give my mum the it, I suggest that since eating disorders have a dyadic pleasure of seeing me healthy and happy.” component that takes place in a relational constellation between a person and her or his attachment figure, This horrifying sentence, which Tanya uttered with a psychotherapy is a fertile ground for enacting such eating- mixture of pride and disgust, illustrates this article’s disordered relationships, enactments which mostly occur suggestion – that eating disorders should not only be seen somatically. In short: relationships (therapeutic ones as an individual condition but instead also as a systemic - included) could manifest disordered-eating patterns. familial disorder. Speaking in feeling Tanya’s relationship with her body, with eating, and with food cannot in my mind be separated from her Psychoanalyst Diane Barth (1998) describes how some relationship with her mother: a relationship of use and clients “speak in feelings” and not in words. These clients misuse, characterised by role reversal and enmeshed are not incapable of articulating their experience in words, digestion. This is a world where it is unclear who is if requested or called to do so (by an attachment figure, digesting what and for whom, a world where the girl for example, or a therapist), but it is not their main way of could not individuate since the mother needed her processing some specific emotions. Barth argues that connected, and where dyadic regulation was harnessed many clients with eating disorders tend to “speak in from an early age to manage and monitor the mother’s feelings,” and that this way of speech characterises both narcissistic anxiety. The child’s body and the child’s normative and pathological processes. The disordered suffering gave the mother meaning – something to worry eating is therefore seen by Barth as somatic about, therefore something to exist for, as her own communication. The feeling-speech is in par with what existence was never validated. You suffer, therefore I am. Wilma Bucci (1998, 2011) refers to as subsymbolic processes: organised, nonverbal, bodily organisations of In this article I suggest that many who suffer from eating language that manifest through gestures, tones, postures, disorders think through their bodies by somaticizing and muscle tension, and more. While this sounds that this early form of somatisation is a result of early revolutionary outside body psychotherapy, it is both well- disturbances of dyadic regulation with the attachment known and frequently conversed with amidst our body figure (most commonly the mother). To simplify this psychotherapy community – we speak in bodies to bodies claim – the disordered body is the mother-daughter dyad who speak with us. and not the daughter (or identified patient) herself.

Names have been changed and permission granted to use the material Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 92

Such clients may be highly intelligent effective because it allows the and well able to communicate their therapist to resonate with the feelings through symbolic means but embodied experience of other as it in so doing something will be lost in emerges in a nonthreatening milieu, it translation. In differentiating between is likely that the empathic mirroring organised and chaotic crying, body of experience offered at such “There are psychotherapist Liron Lipkies (2012) moments is a critical factor in suggested that, “There are moments allowing words to be used where words do not serve us well, symbolically” (p.309). and the language of the body is the most appropriate one to use” (p. 53). I have similarly written of this type of moments It was only after my own Jungian communication when discussing the analyst was willing to roll his chair theory of mind (bodymind) in body towards me and hold my hands in his psychotherapy: that therapy could begin for me. I where words was no longer requested to translate As body psychotherapists, we my experiences into a foreign endeavour to initially speak with language: his body and mine could somatic processes in their own speak directly; and he spoke Body language, rather than forcing these do not serve with me when the therapeutic into symbolic cognitive terminology, material was Body in me, and we since such a transition incurs a loss spoke English when the therapeutic of a qualitatively meaningful aspect material was English. of the conversation, one that belongs in the bodily realm (Rolef Ben- us well, and Many bulimic and anorectic clients Shahar, 2014, p.88). speak in feelings, and their bodies speak with us directly without So far this is great news for body linguistic buffering. At the same psychotherapists. We are trained to the language time, most of these clients are highly work nonverbally, the absence of attuned to their typically narcissistic symbolic communication doesn’t and symbiotic mother (Bachar, 2001; necessarily induce anxiety in us; we Dmochowski, Rolef Ben-Shahar, & can speak with bodies directly. One Carleton, 2014), or to their therapist. of the deserving contributions of of the body Thus, if they perceive that the body psychotherapy to the larger therapist needs them to, those clients milieu of therapy concerns clinical would provide their therapist with the work with subsymbolic processes, necessary verbal engagement, all the working with our bodies and is the most while compromising a deeper speaking with our bodies to the body nonverbal engagement. For those of the person who is with us. clients, “words do not adequately My teacher, Silke Ziehl (2005), has capture or convey emotion or beautifully written about this skill: “I appropriate symbolize experience. Actions, rather can touch in such a way that each than words, often speak of an finger has eyes and ears as I make affective world that otherwise contact with the other person. When I remains uncommunicated and touch in this manner, I am more unconsolidated” (Brisman, 1998, p. likely to be receptive to who the other one to use.” 708). person is, and what they want, and what they are saying with their body Instead of focusing on interpretation, at the moment. From this somatic Liron Lipkies (2012) Barth (1998) emphasises here-and- dialogue, we get to know each other now engagement and attention to more deeply.” action. In discussing Barth's attempts to work affectively and nonverbally Indeed, many psychotherapists and with these clients, Judith Brisman psychoanalysts understand today that (1998) writes: “The process is there is a gap between contemporary

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analytic thinking and Whose digestive system is it organisation, resulting in “uniquely conceptualisation and its translation anyway intertwined, somatopsychic into action. Contemporary analytic personality organization – one that I practice is sometimes found wanting I like to think we have two types of call a ‘perseverant’ personality” in skills and methods when bodies, one that is ours—bounded (p.708). attempting to address affective, within our skin— and another within somatic and otherwise subsymbolic which we share, a body that comes to This is closely related to what I have or unsymbolised processes be fully realised only in connection. previously (2014) called the dyadic- (Ramberg, 2006; Stern, D. B., 2010; When we occupy one (individual body. The attachment system (parent- Stern, D. N., 2002, 2004). body), we yearn for the other (shared child) begins as a dyad; a shared Body psychotherapy can assist body); when we share in a body, we sense of belonging and sharing-in- therapists from other fields in crave our individuation; and when we being is, in my opinion, parallel and acquiring such skills. Below is an are able to hold the tension between not hierarchically secondary to the illustrated example from a training both, an intersubjective body comes individuated self. It means that you situation: to life. I have spoken of these two and I (or mother and baby) create and bodies extensively (Rolef Ben- form the usness, and that at the same

I like to think we have two types of bodies, one that is ours—bounded within our skin— and another within which we share, a body that comes to be fully realised only in connection.

Rita is a trainee body Shahar, 2013a, 2013b, 2013c, 2014). time this usness creates, forms, and psychotherapist. She is also a very shapes us both. Inasmuch as we are experienced Yoga therapist and In her endeavour to understand the bodies, we first share in our bodies, teacher. Rita sits with Avner, who aetiology of eating disorders, this is the somatic aspect of speaks of his mutual desire for and psychoanalyst Alitta Kullman (2007) intersubjectivity. As attachment anxiety of relationships. Rita listens attempted to characterise the theory theory argues (Ainsworth & Bowlby, attentively, and they speak. At some of mind of bulimic clients. She 1991; Bowlby, 1988; Bretherton, stage Avner becomes physically believed that most bulimic clients 1992), we require a sufficiently stable agitated, and as they speak he points resolved to end their symptomatic attachment figure (or dyadic self) for at his stomach and chest with behaviour daily. They want to cease our individual self to emerge safe and distress. Rita, without stopping the this behaviour. Time and again, they regulated. verbal exchange, gestures towards vow to stop binging and purging, her own body, as if asking Avner to only ‘something happens’ and they When failure to attune occurs during clarify something and indeed, he lose their resolve, falling into the a fragmented or oral developmental does. Now she knows, and Rita slippery slope of cyclical binging and stage, the infant might not develop contorts her face, her somatic purging. Similar to Barth (1998) and sufficient self-regulatory capacities empathy is visible, and exhales with a Brisman (1998), Kullman proposes but instead manifest compensatory sigh. She gestures and Avner lies that bulimic sufferers tend to think regulation strategies (what Winnicott down. Throughout this conversation, with their bodies and their turning to (1960) might call the false self). The the verbal and nonverbal are food is first and foremost to help with body would nonetheless not fully concurrent. These are both organised. this thinking. form as separate but continuously Avner and Rita speak perfect Hebrew dialogue, as we could have seen from and perfect Body. Kullman (2007) emphasises the Tanya's statement in the beginning of cyclical nature of bulimia, this article, with the other, But when the main spoken language hypothesising that the aetiology of unfulfilled, half. Seeking to digest is Body, transference dynamics also these cycles may be found in the feelings, thoughts, and decisions speak bodily. And when the client nursing infant sensing lack of psychic cannot be attained on her or his own. brings patterns of eating disorders, contact with his or her feeding this may challenge the therapeutic attachment figure. This pre- If these patterns of relating to self and relationship and introduce elements attachment failure is, according to others are indeed primarily somatic, of disordered-eating into it. Kullman, at the heart of the bulimic then how do these attachment

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organisations manifest in the term work, poor girl. Can I help her? her, again. therapeutic relationship? I think I can. Frozen chicken-wings? The next section will conclude this This is really disgusting! But I don’t And, of course, Billie was used, and article with a clinical example, like this hour very much, it’s too late she too, used others, all her life, and demonstrating the tides of rupture for me. I wouldn’t want to see her her mother was the first but sadly not and repair in an eating disordered regularly at this time. Maybe I can the last in a long chain of uses and relationship dynamics. Please read it check with Billie if she is willing to misuses and abuses. It is so easy to with kind eyes, this is an exposing move to an early morning slot. But use her. It was so easy for me. And I piece for me. It took place about six we have just started and surely, could use her in a way that felt years ago. creating so much instability to begin therapeutic and loving, caring and with is not good for her. I stop containing. Nothing but the truth thinking when Billie is looking at me. “Are you ok?” she asks. Two years later Billie debates about a Two weeks after commencing new job offer. “I am not sure I can therapy with Billie, I accidentally I am shocked by my lack of presence trust you to listen to me well,” she saw her while doing some shopping with Billie and feel shame and fear. I says, “you are so important to me with my daughter. Without thinking, want to tell her that I am usually a that I would read every facial I picked my daughter up in my hands better therapist, that I can be expression and interpret any and ran. I ran and ran and ran and empathic and present, and that she comment you may make and it would hoped that Billie did not see me. I deserves more, that she deserves my influence my decision.” Her words hoped she did not see me, I really full attention. However, I find myself are like a knife to my heart. “I think did. I did not stop to think what nodding and saying, “I’m ok.” Yet you are right there, Billie, you too are would have been so horrible if she again, I evade Billie’s question by important to me, and I would did. We hid in a toyshop for fifteen turning the attention back to her, and probably have feelings about your minutes. I bought my daughter an she is kind enough to have an anxiety decision and you would then notice overpriced toy she did not need. attack. I am called to attend. Now she them. Perhaps you should wait a little Ten minutes into our next session fully has my attention. “What’s going before sharing this with me.” Billie Billie mentions this in passing: “I on Billie, what’s happening?” Billie sighs. “But then I will remain alone think I saw you on the weekend, in a is crying. “I don’t know,” she keeps with my decision.” I nod. “Yes you shop”. I shake my head: “I don’t saying. “I don’t know.” will, but at least you will have you. think I was there on the weekend.” And you can share this with me next She looks at me with disbelief. I ask At home I realise that what was week.” And Billie does, and our myself, why am I doing this? but it’s happening was me, and us. It wasn’t binges and purges reduce as hers ease too late. “I am pretty sure I saw you,” her that was going on, it was us. I as well, and our lies are admitted Billie tries again. used her pain to manipulate her away quicker as our love unfolds. And our from our relationship and away from different, individuated bodies ache as Billie is bulimic, trying to understand me and my shitty behaviour. I barely they yearn for the symbiotic what’s happening to her, hoping to hold back from calling her all week. connection we once knew but we stop these tormenting cycles of And then we meet. And I admit learn something new. We learn how binging and purging. Her breath seeing her with my daughter and to remain separated while smells acidic, and she is beautiful, running and hiding, and admit my connecting, and how to remain clever, and funny. I could have easily lack of presence during the session. I connected when we part. fallen in love with her (and two years apologise for lying. “Why did you do later I would). I bring us back talking that?” she asks. “Truthfully, I don’t I hope that we can share some interests about her eating, and Billie obliges. know. But I felt shitty enough about and dialogue, and I welcome your She goes into the graphic details: it to lie to you.” And Billie smiles, “I feedback, comments, questions and frozen bread-crusts, half a feel like that all the time.” challenges. You can email me at cheesecake, frozen chicken wings, a [email protected] loaf of bread. A loaf of bread, and I Billie talks about her mother, and I Asaf Rolef Ben-Shahar PhD, has been feel her dread; frozen chicken wings, realise how her description rings true a psychotherapist, writer, and trainer and my relief is palpable. I feel much to my feelings since we started since 1997. As a psychotherapist, he better now, thank you. working together. I notice how works as a relational body- I wish to share with you some of tempting it is for me to blame her for psychotherapy, integrating trancework what is taking place in my mind the projective identification. I can and Reichian body-psychotherapy within while Billy is talking: ok, this is long actually feel the seduction of using a relational framework. He enjoys writing and has Continued on page 108

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Research in Review: A Brief Look at Current Studies in the Literature

By Dawn Bhat, MA, MS, NCC

Research from the fields of contemporary medicine and mental health is increasingly validating the mind-body continuum, the heart of somatic studies. Drawing from clinical and basic science, phenomenological and case studies, and literature reviews, this column is dedicated to sharing research from multiple perspectives that may potentially impact the field of body psychotherapy.

Managing Mood with Food

Gardner, M. P., Wansink, B., Kim, J., & Park, S.-B. (2014). Better moods for better eating?: How mood influences food choice. Journal of Consumer Psychology. doi:10.1016/j.jcps.2014.01.002 j.jcps.2014.01.002

The present study examined the influence mood has on food preferences. Positive mood supported the importance of long-tern goals such as health and led to greater preference for healthy foods over indulgent foods. Whereas, negative mood supported the importance of immediate, concrete goals such as mood management and led to greater preference for indulgent foods over healthy foods.

The Body and Eating Patterns in Women

Allen, J., Gervais, S. J., & Smith, J. L. (2013). Sit big to eat big: The interaction of body posture and body concern on restrained eating. Psychology of Women Quarterly, 37(3), 325–336

Expanded and constricted posture moderates body image and contributes to food intake in women. Feminine stereotypes suggest women be small, restrict movements, speak softly, and limit food intake. The present study examined whether women with expanded and constricted postures moderated the relation between body image and restricted eating. As predicted, women sitting in expansive postures restrained their eating less compared to women in constrictive postures. As such, postural constriction strengthened the link between body image and restricted eating.

Dawn Bhat, MA, MS, NCC, holds graduate degrees in General Psychology and Clinical Mental Health Counseling and is a Nationally Certified Counselor. She has experience in neuropsychology and has training in somatic modalities, including Somatic Experiencing and Focusing. Dawn receives clinical supervision from and is a psychotherapy researcher under the guidance of Jacqueline A. Carleton, Ph.D. of the USABP. Feel free to reach Dawn: [email protected].

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Eating Psychology: The Role of Nature and Nurture

Racine, S. E., Keel, P. K., Burt, S. A., Sisk, C. L., Neale, M., Boker, S., & Klump, K. L. (2013). Exploring the relationship between negative urgency and dysregulated eating: Etiologic associations and the role of negative affect. Journal of Abnormal Psychology, 122(2), 433.

Negative urgency is the tendency to engage in rash action in response to negative affect, which contributes to individual differences and personality traits involved in the psychology of eating. The present study examined the genetic and environment associations with dysregulated eating (binge eating, emotional eating, etc.) and established the relationship between negative urgency and negative affect. In a sample of 222 same-sex female twin pairs from the Michigan State University Twin Registry, genetic factors accounted for the phenotypic association found between negative urgency and dysregulated eating (62-77%). Negative affect and negative urgency covaried significantly and was controlled for in the previous analyses. On the other hand, non-shared environmental factors accounted for the rest of the association (23-38%). Interestingly, the non-shared environmental factors were unrelated to negative affect. The authors conclude that emotionally based actions (i.e., negative urgency) coupled with negative affect increased genetic risk associated with dysregulated eating. As such, this study showed that mood and genetic factors play roles in the psychology of eating.

To read more resource reviews written by our USABP Interns under the direction of Dr. Jacqueline Carleton, as well as in-depth book reviews shared in Somatic Psychotherapy Today, please be sure to read the International Journal for Psychotherapy (IJP), a peer-reviewed, scientific journal (their header is hyperlinked).

IJP is published three times a year in March, July, and November, by the European Association for Psychotherapy (EAP). The EAP is a member of the World Council for Psychotherapy (WCP); and an International NGO member of the Council of Europe.

For more details about the EAP, please go to the EAP website: www.europsyche.org IJP Editor, Courtenay Young, [email protected]

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Integrative Body Psychotherapy

Somatic Integration is the latest innovation in the mental health field.

Dr. Jack Lee Rosenberg, founder of Integrative Body Psychotherapy (IBP) and co-developer, Dr. Beverly Kitaen-Morse have been recognized and honored as pioneers in somatic psychotherapy.

The IBP Central Institute, Venice, California, offers certification training programs for mental health professionals and allied professionals, as well as a personal development track.

IBP is a non-invasive somatic psychotherapy that treats the whole person, integrating body, mind, emotions and spirit, enabling you to do deeper, more meaningful work in less time with more lasting results. IBP integrates the best approaches from Eastern and Western psychological, physiological and spiritual body-mind theories and practices into a highly efficient and effective somatic implementation model for psychotherapy.

IBP experiential practices enable you to break through old, somatically maintained dysfunctional behavior patterns by reawakening and establishing fully integrated states of well-being, constancy and sense of self in the body. This facilitates a transformation of consciousness at the core of one’s being.

Three Training Tracks 3-year Mental Health or Allied Professional Certification. 3-year IBP Teacher Training (Requirement: 3-year Certification completion). 2-year Somatic Integration for Personal Growth and Well-being.

IBP Teachers and Curriculum

All training programs and introductory workshops are taught by experienced, licensed and certified IBP teachers. IBP teachers practice and embody what they teach. Diversity scholarship available for qualified mental health professionals.

For more information or to register for training programs or workshops:

www.ibponline.org or (310) 395-2117

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Jacqueline A. Carleton, PhD and the USABP Interns

create a space for clinicians in which they source of further inquiry might involve can feel safe to acknowledge their own clinicians who have found a means of personal issues that may affect their work, separating themselves from their therapy urging each and every clinician to allow work. However, Adams might conclude themselves to feel vulnerable, counter their that this really isn’t possible. Overall, shame, feel less impervious to the demand Adams has written a well-reasoned and to feel perfect and unscathed, and to reach compelling book arguing that therapists out to other professionals in their should feel more empowered to consider communities. their own needs in addition to those of their patients. Her first and last chapters are what I find to be the most central in understanding a broad overview of the various themes that she explores in the lives of her sample. Although one of her shortest chapters, the The Myth of the Untroubled Therapist: first chapter acknowledges the importance Private Life, Professional Practice of personal motivations in the lives of the therapists she studied, arguing that these By Marie Adams. 2014 therapists should feel compelled to be aware, present with and critical of these Reviewed by Phillipe Kleefield, New York personal motivations as they engage with University their patients. Stressing the need to not feel above patients, she instead wants clinicians The Myth of The Untroubled Therapist: to deconstruct and reflect on their own Private Lives, Professional Practice, behaviors, reactions, and experiences in the written by Marie Adams, is a frank, warm, therapeutic process. Serving as a sort of and refreshing read for any clinician discussion and culmination of her study, A Primer for ICD-10-CM Users: working in the field of mental health. the last chapter explores each prior issue in Psychological and Behavioral Conditions Through the qualitative study of 40 further depth and advocates not only for the clinicians throughout The United Kingdom importance of supervision for clinicians but By Carol Goodheart. 2014 and Canada, Marie Adams seeks to engage that they develop an individualized strategy in “consciousness raising”, creating a space to mitigate issues that could come up in Reviewed by: Joshua D. Wright, Hunter in which clinicians can come to feel more therapy with patients. College of the City University of New at ease in knowing that many professionals York in the field face personal issues that can Adams’ book explores the needs and issues come to affect their work. Analyzing the clinicians face in working with patients Carol D. Goodheart had two purposes for data from her various interviews, Adams through a therapeutic process. It is at times writing A Primer for ICD-10 Users: has found that most of the clinicians she ironic to read how unwilling clinicians can Psychological and Behavioral Conditions: interviewed had personal motivations for be to take care of their own health and to inform mental health professionals of the entering the field, arguing that these admit their own faults when they are tasked necessary information to use the World motivations exist as both a boon and a with the arduously rigorous responsibility Health Organization’s International disadvantage, allowing for these therapists of making other people better. Adams does Classification of Diseases, and to “pave the to at times feel a greater sense of empathy seem to make the assumption that no way for the successful adoption and use of toward patients, while at other times therapist has successfully found a strategy ICD-11” (p. 3). The guide strives to bridge fostering sharp disavowals or negative to maintain a strict boundary between their the gap between mental health diagnoses in counter-transferences. Adams also explores personal and professional life, paying very the United States and abroad, especially a list of different issues that arose in her little attention to those therapists in her given globalization and the need to adopt a sample of clinicians since they’ve become sample that don’t feel particularly system that “can be adapted across a wide licensed such as depression, anxiety, death influenced by the personal in their work range of cultures” (p.4). in the family, burn-out, shame, and with patients, dismissing these clinicians as narcissistic ideations of wanting to feel not having a full understanding of their This book begins with an overview of the successful with a patient. Adams seeks to motivations and behaviors. I think that a ICD system and points out that ICD codes

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are required by HIPAA standards, and utility, reliability, and validity are clinicians to enter the field of mental thus even for those who currently use the discussed. health and culminates with essays DSM, these diagnoses are translated into addressing later life events within ICD codes for billing and reimbursement Before ending with the full ICD-10-CM clinicians’ lives as examined through a purposes. This chapter provides the code list for mental disorders, Goodheart psychoanalytic lens. This book is clearly necessary background information for gives a brief preview of ICD-11. The written for professionals but could also those who do not understand the ICD and primer provides an introduction to ICD be useful for graduate students training to provides a framework for why with reasons for why its use should be work in the field of mental health. transitioning to the ICD system is considered, explains differences between Although the different essays cover a practical for psychologists in the United ICD-9-CM and ICD-10-CM, and wide range of topics, they’re brought States. previews the ICD-11. The most useful together by what reads as the different component of this book is the appendix, authors using their essays as a respite, a Chapter 3 begins to explain in detail why consisting of the list of codes for the ICD means by which to simply express adoption of the ICD-10-CM is necessary, -10-CM. Another very important part of themselves. The usefulness of this book notably that it will provide better health this book is the listed resources for is more theoretical than practical, an monitoring and classification via a converting codes on page 25. enjoyable and interesting read into the “wider range of diagnostic scope and personal lives of different clinicians. content” (p. 21). According to the I am not sure that this guide will “pave primer, the new ICD-10-CM is easy to the way for the use of ICD-11”, but it The theme of the first part of the book use because it consists of ten categories does give an overview of the use of ICD- appears to reflect on clinicians’ personal of diagnoses for mental health that are 10-CM assuming a previous knowledge experiences that influenced their current easy to navigate. Multiple examples are of ICD in general. Without some practice. What is most striking about provided utilizing the value structure of previous knowledge of ICD, this primer these different essays is their ability to the codes that help make clear the codes’ likely will not provide sufficient create a sense of engagement with each structure, and a number of resources for information for converting it to practice. author, due to the honest, personable and easily converting DSM codes into ICD- fair style in which they are written. 10-CM codes are provided on page 25. Reading these essays you sense that you Many coding incompatibilities are noted are “getting” these divergent clinicians— between ICD-10 and ICD-10-CM due to you understand where they are coming differences in diagnosis categories from and also experience some of what between the ICD-10 and the DSM. An the authors are writing about. example being F41.2 (mixed anxiety and depression disorder), which is included The essays in the second part of the book in the ICD-10 but omitted in the ICD-10- read as more mature; yet, they continue CM, making the codes skip at times. to preserve an honest and self-reflective Goodheart notes “remember the basic style in their approaches to their rule: Use an ICD-10-CM code if you are respective subject matter. Addressing billing a third-party payer” else the claim less inchoately formative experiences, will be rejected (p. 35). these essays focus on issues that clinicians dealt with in their personal Goodheart claims that “the greatest lives in their more adult years. While benefits of ICD-10-CM accrue mainly to Clinical Implications of the these different essays focus on very those who aggregate and analyze large Psychoanalyst’s Life Experience: personal issues, they continue to weave amounts of health data”, rather than When the Personal Becomes the professional dimensions in. practicing clinicians (p. 40). This will Professional. primarily improve cross comparison of Overall, Clinical Implications of The morbidity and mortality statistics, quite Edited by Steven Kuchuck, 2014 Psychoanalyst’s Life Experience is an useful for public health. As a note to engaging read of interest to professionals epidemiologists and health researchers, Reviewed by Phillipe Kleefield, New who are looking to step out of their own GEM’s (General Equivalence Maps) are York University figurative shoes and see where their noted as way to convert from ICD-9-CM colleagues are coming from. Kuchuck to ICD-10-CM or vice versa for Steven Kuchuck has compiled and edited aimed to create an academic space continuity purposes. Goodheart’s major essays written by several professionals devoted to the lived experiences of complaint as to ICD-10-CM’s failure to working in the field of mental health in clinicians and I think that through this drastically improve practice is that the hopes of addressing a dearth of academic compilation of essays he was successful ICD-10 is already 20 years old and that writing that provides a space for in accomplishing this. the main struggle in practice is the clinicians to express their personal accuracy of codes, not necessarily the stories. Dividing Clinical Implications of need for more codes, which is the main the Psychoanalyst’s Life Experience into difference between ICD-10-CM and ICD two parts, the book starts by addressing -9-CM. Further problems of clinical early life experiences compelling

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Trying Not To calming. This research is balanced and As a resource, the APA Dictionary of Try: The Art provides a modern perspective. Clinical Psychology is a well organized and Science of and accessible tool. The definitions are Spontaneity. Trying Not To Try is a unique, interesting concise and most are not longer than a and informative read. It explores the few sentences. There are two appendixes By Edward notion of spontaneity as something that that separate the content into biographical Slingerland. requires practice, patience, and skill. entries and psychotherapeutic entries. 2014 Framing spontaneity as something ideal The biographical entries contain and extremely positive is highly novel in rudimentary information about important Reviewed by light of Western ideologies that stress figures in the field, such as Freud, Phillipe routine, organization, planning ahead, Pavlov, and Jung. The psychotherapeutic Kleefield, New and “being on top of it”. Through entries contain many different types of York University exploring ancient Chinese therapies, trainings, and analyses. conceptualizations, Slingerland examines Edward Slingerland has written both an spontaneity, or Wu-Wei, in the context of While this dictionary is clearly a well- interesting and informative book that practical lifestyle changes that can lead written and organized resource, I would explores the notion of spontaneity and someone to achieve a state of “flow”. recommend any interested party to wait addresses how one can achieve it. before purchasing. The preface mentions Spontaneity is usually thought of as APA a second edition coming out later in acting in an undetermined way or making Dictionary of 2014, and it would be beneficial to a decision in the moment; however, Clinical examine the differences between the two Slingerland offers a more nuanced Psychology. editions. For those more technologically definition, positing that spontaneity is savvy the APA offers this edition in a more like a “state of flow” in which Edited by Gary digital format. someone isn’t necessarily thinking “how R. VandenBos. to” but is in fact “doing”. Furthermore, 2013 Body Mindfulness spontaneity, although usually thought of Workshop with Dr. as describing someone who might be Reviewed by: Marjorie Rand impulsive or unplanned, is Dorothy [DVD]. conceptualized by Slingerland as Luczak, requiring practice, effort, and mastery. Columbia Created by Marjorie This notion of spontaneity has historical University Rand. 2013 precedent that is deeply rooted and highly theorized in Chinese culture, effectively The APA Dictionary of Clinical called Wu-Wei, non-action (or non- Psychology is another step forward in the doing). Singerland ventures into attempt to define the numerous topics discussing Wu-Wei through various within psychology. In fact, this is the Reviewed by: Chiroshri Bhattacharjee, chapters, advocating this as a lifestyle fourth edition since its inception in 2006. Stony Brook University that can lead to success, productivity, and Although this edition is not as expansive happiness. as the first, it caters to a specific audience Body Mindfulness is a technique that whereas the original was a compilation of incorporates an Eastern approach to body The next chapters of Trying Not To Try and aims to assist those working in the alignment in order for the energy to move complement the first two chapters in field. around the body while regulating the providing a good account of how nervous system. Dr. Marjorie Rand, a someone might go about making changes What makes the APA Dictionary of well-known somatic psychotherapist, that will allow them to achieve Wu-Wei. Clinical Psychology different from demonstrates an interactive workshop These practical sections of the book are previous editions is that the entries were that can serve as a comprehensive guide thorough, unique, highly engaging, and chosen for their relation to clinical for beginners interested in practicing allow someone to learn how to put these practices, such as assessment, evaluation, Body Mindfulness. The workshop is behaviors into practice in their lives. diagnosis, prevention, treatment, etc. The organized in four parts. Each part hope was to “prove a convenient and focuses on different body parts and Whereas most of the book is focused on highly focused alternative for women and demonstrates different techniques. In the exploring ancient conceptualizations of men at the very heart of the first part of the workshop, Dr. Rand spontaneity, or Wu-Wei, Slingerland does psychological enterprise.” However, this delineates the symptoms and the negative do a good job of interweaving more dictionary is not exclusively for effects of anxiety. Later, she proceeds to westernized scientific literature and clinicians; it is also recommended for explain the ways to tackle anxiety, stress, research into the different chapters. These “students - especially those in training as and other panic disorders. The first additions are compelling as they clinicians” and “consultants to technique she shares is body alignment. complement the more Eastern approaches professionals in such fields as medicine, This ensures that there are no blocks in with tangible, experimental evidence, law, social work and consumer the body and the energy can easily flow something that many readers of this book relations.” down to the feet. According to Dr. Rand will likely perceive as soothing and

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body alignment is a crucial step to body understanding of why one would pick up What is PTSD? 3 Steps to Healing mindfulness because it allows the energy this book to begin with. It sets a sort of let Trauma to flow through the body thus regulating -me-take-care-of-you tone. Or even a, let- the nervous system. me-help-you-help-yourself type essence. By Anna Baranoksky and Teresa Lauer. Are you feeling lost, insecure, unsure? Do 2012. In the second part of the workshop, Dr. you feel a disconnection between yourself Rand demonstrates a breathing technique and others, maybe even between your Reviewed by: Rachel Vitale, NYU with a focus on pressure points. In the mind and body? This book is meant to lift third part, she proceeds to demonstrate the you up and place you down right where Dr. Anna Baranowsky and Teresa Lauer, chest exercise technique and the you want to be. That much is clear just LMHC have come together to write a self- abdominal breathing technique to ensure from reading the introduction. help manual that both educates one on proper neural network and a smooth flow what exactly Post-Traumatic Stress of energy. The workshop ends with part These client-therapist sessions highlight Disorder is, and how to go about treating four comprised of discussions and the concept of trust in oneself and trust in oneself. The most important feature of feedbacks from the participants. During others, which is also a key theme this book is the explanation of PTSD. the course of the workshop, Dr. Rand throughout the book. Understanding the PTSD is a disorder often heard in explains the vitality and the benefits of importance of trust will bring readers reference to the men and women who Body Mindfulness. She also encourages closer to an understanding of source have served their countries in the armed continuing the techniques on a regular energy. Following the introduction is a forces. It is often publicized on the news basis for improvement in both physical chapter devoted entirely to source energy. and other forms of media. The detailed and mental health. The workshop is easy For those who are not familiar with this description of this disorder that the book to follow, introduces the participants to concept, the book provides a detailed provides is better informed than any the ideas of Body Mindfulness, and explanation covering everything from information a news broadcast can bring. allows them to go through some of the what it means to how to embody this The authors use soft, nurturing language preliminary steps and techniques. force. Whether you’re a twenty-one year throughout the book to make their readers old college student who’s never heard the feel calm, almost at ease. It’s almost as if Body Mindfulness is relevant for people term source energy or a middle-aged to say, “Don’t worry, we know. of all ages from children to the elderly. therapist who’s been practicing for years, Everything will be ok.” Dr. Rand encourages people to follow the this book tries to speak to you in whatever routine as a family or as couples. way you need in that given moment. The main idea presented in this book is According to Dr. Rand, this would have a that there are three essential steps to significant positive impact on the The remainder of the book analyzes healing the trauma inflicted on oneself by relationship and family. The DVD is source energy in even more detail, going PTSD. The first step is to find comfort. designed for beginners with no prior into what blocks source energy, along The authors explain that by finding a knowledge. with how to awaken this energy. The book stable support system, it will be that much is concluded by a note from the author, easier for an individual to gain self- Focalizing which is my personal favorite part. It’s not confidence and overcome trauma. The Source Energy: simply what words the author chooses to second step is to remember the trauma. Going Within leave his readers with, but more so the This step appears to be the most difficult to Move pure honesty that you can hear behind of the three, but through Baranowsky and Beyond each page. This is an honest concept Lauer’s kind, encouraging words, readers written by an honest therapist crafted into will feel as if they are being taken by the By Michael an honest book. And honestly, it’s good. hand through an unforgettable journey. Picucci. 2012 Being able to remember one’s trauma means that one is ready and able to face it. Reviewed by: It is only then that an individual can move Rachel Vitale, on to the third and final step of New York overcoming trauma. University The third step is, as the authors phrase it, Flip past the beautiful color explosion of “begin to live again!” Once an individual bold orange and cooling blues on the is able to find a team of support in which cover, and dive into an intense interaction comfort is most felt, the trauma can be between client and therapist. Michael faced head on, and in turn, the person can Picucci offers four moving pieces, each begin to finally live life again to the broken into two parts: one part written fullest. Never have I read a book that from the perspective of the client, and the made battling a disorder feel so uplifting. other written from the perspective of the therapist. This powerful introduction not only prepares the reader for what’s to come next, but it allows for an

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Psychotherapy: his form of therapy effective: stressing discovered throughout the years. This Lives not to push patients to analyze the book contains an array of tools for Intersecting transference but instead come to their dealing with emotional eating that own conclusions in their own time; being includes journaling, meditation, creative By Louis a personal and open therapist; fostering a visualization, energy techniques, and Breger. 2012. relationship with patients such that this conscious living. relationship cures prior unhealthy Reviewed by experiences; acknowledging mistakes; In the first chapter, Beck tells the story of Phillipe disclosing of personal information as long her struggles with food. For years she was Kleefield, New as it benefits the patient; having a sense a closet eater and yo-yo dieter. She recalls York University of humor; allowing for and cultivating the inception of her eating habits during patients to undergo other forms of therapy her childhood and provides insight as to while in psychotherapy; advocating for co why she began over eating to fill the Psychotherapy and psychoanalysis are -construction of insight and emptiness inside her. This awareness was words that can conjure mixed feelings interpretation; and having flexible fees. something she had developed through her about the usefulness of their processes, recovery. Chapter’s Two through Eight whether they are worth the expensive Psychotherapy: Lives Intersecting cover three days of the plan so that the undertaking, and other similar advocates for a less orthodox model of book progresses chronologically. Chapter introspective thoughts, all of which lead psychotherapy and psychoanalysis in Two is about becoming self-honest. to the central question: are psychotherapy which the therapist doesn’t simply serve Readers can take a mini-assessment to see and psychoanalysis really for me? as a projection onto which a patient can if they have emotional eating problems. Whether psychoanalysis is a good choice place his own thoughts and feelings but The assignments for the first three days is the central question that I believe has can also interact in a more active way. involve writing your eating history, which prompted and informed Louis Breger to Breger does a good job of delineating involves reflecting on the past to see write his book, Psychotherapy: Lives what made his style of therapy when and how the emotional eating Intersecting. This book involves an particularly effective; however, the reader began; keeping a food mood diary (for all exploration through the lens of those should come to the decision by himself or 21 days of the program), which includes patients that he has treated in the past, herself of which therapeutic style would writing down all food eaten along with including what is unique in his be most useful. your mood at the time and the relevant psychotherapeutic analysis, what circumstances; and keeping a journal “worked” for his patients, and for whom Stop Eating Your since the focus of this book is the his therapy was not an ideal fit. Breger Heart Out emotional aspects of overeating. The orients his book toward patients that remaining chapters discuss finding might be considering psychotherapy, in By Meryl Hershey support, spirituality, energy techniques, addition to other psychotherapeutic Beck. 2011. going within (oneself), personal clinicians, as a means of juxtaposing his housecleaning, conscious living, and a less orthodox, more relational form of Reviewed by: review, respectively. Beck approaches the psychotherapy in contrast to more Mona Zohny, issue of emotional eating from every traditional psychoanalysis as advocated Hunter College angle. by theorists such as Sigmund Freud. Through the long-term follow up of his Throughout the book, she touches upon patients, Breger offers an insightful and the influence Alcoholic Anonymous honest analysis of what his more groups have had on support groups for successful patients found important about eating problems, since emotional eating his therapeutic style (he also addresses In Stop Eating Y our Heart Out, Meryl can be considered a food addiction. the responses of those that didn’t find him Hershey Beck offers readers a 21-day These 12-step programs have influenced particularly useful), allowing for readers program that will help “release [them] the program that Beck has developed in to carve their own path in coming to a from [their] emotional dependence on this book. She uses some of the same conclusion about whether psychotherapy food” (xix). This self-help book is a activities including a simplified version and psychoanalysis might be a useful valuable resource for both sufferers of of a moral inventory assignment used in journey. eating disorders, such as binge eating AA groups, which involves taking a look disorder (BED) and compulsive at “character traits that have outlived their The final chapters of Breger’s book are overeating (COD), or people that want to usefulness” in order to free oneself from what I find to be the most important in his change their unhealthy relationship with them (p. 141). book. These chapters illustrate what it is food. Beck is a self-proclaimed that Breger’s psychotherapy entails and “(recovered) food junkie” (xvi). She says Another interesting concept that Beck subsequently what specifically works that “food was the glue that kept [her] learned about during a 12-step program is about his form of psychotherapy. In together” (xvi). She has also been treating the idea of one’s Inner Child. The Inner addition to the positives of his work, there patients with BED and CO for over 20 Child is a “metaphor for the precious is also an account of what some didn’t years. Her experiences enabled her to child we all were who often had find useful. Breger believes that the create a practical plan encompassing all unexpressed feelings and unmet following characteristics are what makes of the beneficial techniques she has needs” (p. 115). The assignments

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surrounding this concept involve spirit away from the escapism that eating developing and using a Nurturing Parent/ Margo Maine, William N. Davis, and disorders engender. In “ Individual Healthy Adult part of oneself to create a Jane Shure, collective editors of Psychotherapy for Anorexia Nervosa and dialogue with the Inner Child through Effective Clinical Practice In The Bulimia: Making a Difference”, William which healing can occur. Treatment of Eating Disorders: The N. Davis outlines the two forms that Heart Of The Matter, seek to create an eating disorders take – the diet as the Beck explores the idea of energy alternate framework for clinicians that distraction and the diet as all- techniques such as Emotional Freedom counters the traditional “Medical-Model” consuming—and discusses how a Techniques (EFT) and Rapidly paradigm in the treatment of women with clinician can engage patients through Integrated Transformation Technique eating disorders. Their framework takes therapy such that the attachment to the (RITT), which she developed with as its central assumption that women eating disorder is replaced by one with Robert Trainor Masci. These techniques require specialized therapeutic the therapist and one outside themselves. involve tapping on certain pressure ideological constructs for effective In “Developing Body Trust: A Body- points and repeating a phrase. EFT treatment—“ a Feminist Frame”—that Positive Approach to Treating Eating usually involves one feeling while RITT emphasizes relationships as Disorders”, Deb Burgard sees the encompasses many feelings at once. The fundamentally critical to the well being adversarial relationship that women goal is to neutralize negative emotions by of women. Emphasizing connection, develop to their bodies as influenced by affecting the flow of energy in the body. empathy, and “being present” in the culture and social norms as something These techniques are used for patients therapeutic process in firm opposition to that can be fixed. Burgard advocates for with anxiety, depression, and eating traditional clinical pedagogies of women to “listen to their bodies” and disorders. The assignment provided in individuation, distance, and separation, understand that their bodies can regulate this book is designed to help emotional Maine, Davis, and Shure have compiled themselves and make up for any eaters curb their cravings. However, practical articles by seasoned clinicians “mistakes” that may be perceived. Beck encourages the use of these highlighting the qualitative component of techniques whenever any negative eating disorders, and as such, effectively The book’s second section, Effective emotions begin to surface and integrates delineate not only the therapeutic Clinical Practices: Methods, offers them into other parts of the recovery theoretical framework they envision but articles addressing different therapeutic process, like with the Inner Child work, also how it can be realized. processes and the respective issues that since one’s Inner Child can bring up might arise such that clinicians might be painful memories from the past. The articles are clustered into three able to implement lessons from the larger sections to best orient the clinician. In “Feminist Frame” framework outlined in Beck’s Stop Eating Y our Heart Out is an Effective Clinical Practices: Approaches, the first section of the book. Authors in easy to read book that serves as a the theoretical crux of the book, four this second section address practical tool for emotional eaters. This articles address the framework for how countertransference in psychotherapy, book does not focus on food. Instead, it clinicians should think about and assess family therapy, treating adolescents with dives into the feelings and thoughts their female patients with eating eating disorders, and other practical associated with eating that influence disorders. Each article begins with a topics that ultimately come to serve as negative behaviors like overeating. While background for the respective therapeutic reference guidebooks for clinicians to the author used the concept that it takes suggestion as evidenced by literature, utilize in their practices, or at the very 21 days to break a habit, she encourages followed by a clear description of what it least reaffirm what they have already readers to spend up to a week on a single entails, proceeded by a qualitative been doing. Each article is organized by assignment and to revisit assignments if anecdote demonstrating this “in action”. clinical subdivisions that thoroughly necessary. The personal anecdotes of For example, in “Beyond The Medical outline the clinical concept at work in the Beck’s experiences with emotional Model: A Feminist Frame for Eating therapeutic process that is outlined. eating instill hope in the reader and make Disorders”, Margo Maine explores “a Overall, this methods section serves as a him or her feel like s/he is not alone in Feminist Frame” as a construct in more comprehensive and thorough resource for his or her suffering. detail, highlighting its emphasis on practicing clinicians. allowing women “to feel gotten”, its fostering of openness, its minimization of The last section of this book, Effective Effective Clinical the power differential between clinician Clinical Practices: Special Themes, is Practice in the and patient, its emphasis on mutual devoted to discussing more specific Treatment of Eating growth within the therapeutic process, psychological underpinnings that exist as Disorders: The Heart and how it should be realized. In issues that clinicians working with of the Matter. “Wholeness and Holiness: A individuals with eating disorders may Psychospiritual Perspective”, Steven encounter in treatment. While these Edited by Margo Emmett equates the experience of eating issues may be more specialized, each Maine, William Davis, disorders to the pious, devotional and article is still keenly practical and and Jane Shure. 2009 obsessional form that religion can take thoroughly all encompassing. The and suggests mobilizing these qualities in articles address diverse topics, including Reviewed by Phillipe Kleefield, New therapy in such a way that patients can the role of shame and compassion in the York University become more spiritual and reengage their development of eating disorders, the

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development of negative Each section covers different aspects of how to deal with larger issues that can countertransference during the treatment self-doubt or self-loathing. The common cause anxiety, such as finding one's of eating disorders, and the role that negative statements that might run greater purpose in life. Part Seven serves forgiveness can play in the recovery from through a patient's head are addressed as a general review of the book, allowing eating disorders. Each authors’ article is and then countered with positive self- patients to see how their mentality has well developed and engaging from its affirmations. This book serves as a useful changed before and after using these inception until its culmination. tool for patients who are in the process of strategies to sustain recovery. Golden recovering from bulimia. It is meant to also provides a list of fifty things she Maine, Davis, and Shure have be a “complement to formal treatment used to believe were true and fifty successfully put together an informal programs” (p. 8). The strategies in this affirmations to counter them, side by handbook for the treatment of eating book are ones that Golden has developed side. disorders in women. Although the book and used herself in recovering from a 25- is made up of articles written by different year battle with her eating disorder. This Each chapter starts off by addressing a clinicians, each chapter consists of an book is divided into seven sections that particular issue that a bulimic typically article that continues to fall under the are then divided into chapters. The first deals with. Golden acknowledges these larger “Feminist Frame” umbrella, part of the book is about learning to love problems and discusses where they stem creating a refreshingly succinct read and accept one's self unconditionally. from. She then explains what can be without losing the framework’s The exercises in this section involve done to change the negative thoughts that cohesiveness and clarity. While it is writing personalized self-affirmations lead to this issue and why it is necessary understandable that there is no mention and making promises to be kinder to to change them. Exercises are then of diagnostic criteria for the different one's self. This unconditional self-love provided at the end of the chapter for the eating disorder subtypes (as the book is enables patients to realize that they reader to complete. For instance, Golden written for clinicians that presumably deserve to get better and are capable of discusses the idea that everyone deserves have an understanding of what it. The second part is about learning more to be happy despite the fact that many constitutes an eating disorder), the about bulimia and understanding that this bulimics do not feel that they deserve it. changing scope of eating disorders destructive disease cannot solve any She points out that bulimics use the through time should warrant clear problems. Educating one's self is incessant binge-purge cycle as a way to definitions. Moreover, the book’s important in realizing there are many achieve happiness (which was based on characterization of women, while it may factors involved and thus alleviating self- weight and body image), and yet, it only not be intended to be rigid, can come blame. seems to cause harm. She encourages the across as somewhat stereotypical, reader to repeat affirmations such as “I catering to an American gender binary in The third part is about taking control of deserve to be happy” over and over again which men are seen as stolid and one's recovery and realizing that it must (p. 38). While she admits that the self- independent, and women as emotional be a conscious decision. Golden touches affirmations may seem “ridiculous and and relational. However, on the whole, upon different ways that can help one fake” at first, she insists that it important this book reaches a good balance of heal such as religion/spirituality and to repeat them until they become truth (p. theory and practice, making for a good therapy. She offers an alternative cycle to 17). She discusses her path to recovery and informative read for clinicians the typical binge-purge cycle that in great detail throughout the book, working with women struggling to involves taking control of one's emotions explaining that these affirmations slowly overcome eating disorders. and dealing with the anxiety that changed her self-loathing to ambivalence normally leads to binge eating then self-like, and finally self-love. The 50 Strategies to specifically by regulating one’s exercises provided at the end of each Sustain breathing. However, Golden suggests chapter really make this book unique. Recovery From that each patient creates an alternative Some exercises involve repeating Bulimia cycle that works to counter his/her own statements given out loud, while others typical binge-purge cycle and suggests instruct the patient to write a list of By Jocelyn that this be done with a therapist. The statements, which can actually be done Golden. 2011. fourth part is about interactions with right in the book, using the space people and how to change judgmental provided. These thought provoking Reviewed by: behavior towards others and one's self. exercises supplement the text, serving to Mona Zohny, The idea is that looking at these reinforce the strategies discussed and Hunter College interactions will help the patient discover ensuring that the patient has mastered the toxic people, places and things that them before moving on. They keep the In Jocelyn Golden's empowering book, trigger his/her bulimia in order to remove reader actively involved in his/her own 50 Strategies to Sustain Recovery From them from his/her environment. Part Five recovery. Bulimia, she outlines many tactics that refocuses on one's mindset, addressing can be used by a recovering bulimic issues like one's relationship with food, 50 Strategies to Sustain Recovery from patient when “the therapist's door dealing with anger, learning to be Bulimia is easy to read and to relate to, closes...or when the support group breaks grateful, silencing the “bulimic voice” (p. as the author has suffered from bulimia up for the evening” (p. 7). The strategies 175) and ensuring that one has all the for a quarter of a century, and so she discussed revolve around changing one's tools of recovery s/he needs. Part Six negative thoughts to positive thoughts. addresses concerns about the future and Continued on the bottom of page 108

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Seven books written by Malcolm Brown, PhD, are now available on Kindle

Malcolm Brown, PhD, is now offering three autobiographical CARLA books as a series of three volumes, including: A young woman who wishes to Part 1: become a psychotherapist in A Volume I: Why an American Body Psycho- young woman, who wishes to therapist Preferred Europe. become a psychotherapist in private practice, must first teach Volume II: Primordial Regression and Ful- in a Swiss country school before filling Sex. she can afford to attend the Uni- versity of Zurich to obtain her Volume III: Europe’s Moderation Versus two degrees in psychology. After successfully establishing a America’s Extremes. private practice in the Swiss city of Luzern, she is determined to do something original and remarkable for the benefit of Swiss practitioners of psychotherapy. She finds a wealthy en- Part II: European Versus American Women. trepreneur who gives her the money to found, build, and admin- ister The Swiss International Training Center for Psychothera- Part III: My Man to Man Relationships to Other Professionals. py. The son of the entrepreneur, John, falls in love with her after the death of his first wife. He gradually convinces her, He is also offering four of his novels including: through the integrity of his behavior, that he really loves her even though she has believed that she would remain single her TWO FULFILLED PEOPLE whole life. They marry and have children and bond heavily through marijuana and hash driven lovemaking for the rest of A history of two young Americans who meet their lives. and fall in love. She gives up her plans to enter a Catholic sisterhood so they can marry and become a close working team in Lon- ROLLAND AND ANGELINA don, where he attends medical school and she works as a supervising nurse. Together Ronald is an American student living in they create and build a systematic treatment Spain and working on his Ph.D. in Psy- program for shell-shocked members of the chology from the University of London, British Armed Forces and settle permanently Birkbeck College. He gives a concert in England on an abandoned English estate with an arrange- singing folk songs and love ballads to his ment to treat shell-shocked members of the American Armed own guitar accompaniment at the Ameri- Forces as well as members of the British Armed Forces. They can Embassy in Madrid. One of the mem- remain bonded and avowed monogamists until death. bers of the audience is Angelina. She is the Duchess of Cordoba and her uncle is the Count of Malaga and a psychiatrist in private practice in Madrid who has befriended Rolland. Angelina tells her uncle, BENJAMIN AND FREDERICA Julian, she thinks she is falling in love with Rolland because of the beauty and power of his singing, and she wishes to be intro- They meet at a student cafeteria at Uni- duced to Rolland the next evening. Julian conveys the message versity College, University of London to Rolland, and he agrees. However, during the night, Rolland after eating there alone for over a year. has an attack of anxiety because Julian says that Angelina is After a year of conversation they discover one of the most beautiful women in the world. This is too each other’s musical talents, fall in love, threatening for Rolland, and he cancels his meeting with her. and later marry. During a holiday trip to His fear of women forces him to take the next airplane to San India, Frederica goes into a malaria coma. Francisco in order to avoid meeting Angelina altogether. Seven Benjamin and Frederica’s mother, who years pass and Rolland meets Angelina after her star perfor- have felt alienated from each other for mance as the feminine lead in the Zarzuela light opera given at years, are forced to sit beside each other next to Frederica’s the Zarzuela Theatre in Madrid. He is so charmed by her sing- hospital bed for over seven weeks and learn who the other one ing and her beauty of appearance that he goes back stage after is. After Frederica emerges from her coma a united and happily the opera is over and invites her to dine out with him. They contactful family slowly emerges. both fall deeply in love with each other during their meal after she reveals to him that she is the Duchess of Cordoba, and they agree to take a hotel room together directly afterwards. They marry and have children and she later becomes the toast of the Metropolitan Opera Company of New York City, Rolland’s home.

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Rolef Ben-Shahar continued from pg. 95 Developmental Psychology, 28, 759 International Forum of -775. Psychoanalysis, 15(1), 19-33. written dozens of professional papers on Brisman, J. (1998). When actions speak Rolef Ben-Shahar, A. (2013a). A cup, psychotherapy, body-psychotherapy, louder than words: verbal and grasping my fingers. Somatic hypnosis, and their integration. He is an nonverbal wrangling in the Psychotherapy Today, Spring 2013, therapeutic arena: commentary on 40-42. international board member for Body- paper by Diane Barth. Rolef Ben-Shahar, A. (2013b). Diagnosis in Psychotherapy Publications and an Psychoanalytic Dialogues, 8, 707- the service of metta. Somatic associate editor for Body, Dance and 714. Psychotherapy Today, 3, 26-30. Movement in Psychotherapy. His book, Bucci, W. (1998). Transformation of Rolef Ben-Shahar, A. (2013c). A duty to Touching the Relational Edge: Body Meanings in the Analytic honor our hearts. Somatic Psychotherapy, was published by Karnac Discourse. Canadian Journal of Psychotherapy Today, 3, 44-48. in 2014. His PhD dissertation (Surrender Psychoanalysis, 6, 233-260. Rolef Ben-Shahar, A. (2014). Touching the to Flow), focused on the moments of Bucci, W. (2011). The interplay of Relational Edge - Body surrender in three different fields: subsymbolic and symbolic Psychotherapy. London: Karnac. processes in psychoanalytic Stern, D. B. (Ed.). (2010). Partners in relational psychoanalysis, body- treatment: It takes two to tango - Thought: Working with psychotherapy and hypnosis, and these but who knows the steps, who's the Unformulated Experience, three form the axes of his theoretical and leader? The choreography of the Dissociation, and Enactment. clinical curiosity. psychoanalytic interchange. Hove: Routledge. Psychoanalytic Dialogues, 21(1), Stern, D. N. (2002). Attachment : From early References 45-54. child-hood through the lifespan Dmochowski, S., Rolef Ben-Shahar, A., & (Cassette recording No. 609-617). Ainsworth, M. D. S., & Bowlby, J. (1991). Carleton, J. A. (2014). Body Los-Angeles: Lifespan learning An ethnological approach to Psychotherapy Treatments for institute. personality development. American Eating Disorders [publication Stern, D. N. (2004). The Present Moment in Psychologist, 46(4), 333-341. pending]. Psychotherapy and Everyday Life. Bachar, E. (2001). The Fear of Occupying Kullman, A. (2007). The "perseverant" New York: Norton. Space: The Self-Psychology and the personality: A preattachment Winnicott, D. W. (1960). Ego distortion in Treatment of Anorexia and Bulimia. perspective on the etiology and terms of true and false self. In D. Jerusalem: Magness. evolution of binge/purge eating W. Winnicott (Ed.), The Barth, D. F. (1998). Speaking of feelings disorders. Psychoanalytic Maturational Processes and the affects, language, and Dialogues, 17, 705-732. Facilitating Environment (pp. 140- psychoanalysis. Psychoanalytic Lipkies, L. (2012). The language of crying in 152). London: Karnac, 1990. Dialogues, 8(5), 685-705. body psychotherapy. (Diploma in Ziehl, S. (2005). Bodywork as poetry. Open Bowlby, J. (1988). A Secure Base: Clinical Body Psychotherapy), Reidman Centre, 29(1)(1). Retrieved from Applications of Attachment Theory. College, Tel Aviv. http://www.entelia.com/ Abingdon: Routledge. Ramberg, L. (2006). In dialogue with Daniel bodyworkaspoetry.shtml Bretherton, I. (1992). The origins of Stern: A review and discussion of attachment theory: John Bowlby The Present Moment in and Mary Ainsworth. Psychotherapy and Everyday Life.

Resources continued from p.106

speaks from experience. In this way, it thought process of a recovering bulimic patient to take realistic steps towards can certainly instill hope in patients who and intervenes at every step to help maintaining their recovery. are struggling with their recovery and instill a solution at the root of the help to empower them. The book is problem (negative thoughts). The organized in a way that truly follows the exercises provided in the book allow the

Poppink continued from page 88

(2006) Trauma and the body: A sensorimotor Behavior under risk: how animals avoid Meloy, R. J. (1992). Violent attachments. approach to psychotherapy. New York: becoming dinner. Nature Education Northvale, N.J. : Jason Aronson Inc. W. W. Norton & Company, Inc. Knowledge 2(11):8.

Meloy, R. J. (Ed.). (1998). The psychology of Poppink, J. (2012). Healing your hungry heart: Schore, A. (1994). Affect regulation and the stalking. San Diego. Academic Press. Recovering from your eating disorder. origin of the self. Hillsdale, N.J.: Harcourt Brace & Company. San Francisco: Conari Press. Lawrence Erlbaum Associates.

Ogden, P., Minton, K., Pain, C., Siegel, D., Rosier, R. L. & Langkilde, T. (2011).

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Dmochowski continued from pg. 55 helping to provide resources that Albany, SUNY. At the New York State have previously not been available. Psychiatric Institute (NYSPI), she was a well as detailed attention to thought This book’s defining strength comes research coordinator for a comparative therapy study of individuals whose restructuring seem to be some of the from its focus on healing the cognitive and emotional components primary diagnosis is Post-Traumatic most helpful chapters in this section. Stress Disorder (PTSD), with outcome Several appendices include extensive underlying the maladaptive use of data from interpersonal, exposure and further resources and readings for sustenance as a coping mechanism. relaxation therapy. She also helped to those interested. If an individual is ready to address conduct research at NYU School of their problematic eating patterns and Medicine’s BODylab (Brain, Obesity & Binge eating disorder is a recent wishes to make some lasting and Diabetes) in a study that investigates the addition to the recognized eating healthful changes, this manual impact of obesity, insulin resistance, and disorder diagnostic categories and as appears to be a very good place to Type 2 Diabetes on brain and cognition a result few authors to date have begin. in both teens and adults. A former professional ballerina with Boston Ballet directly addressed the mechanisms Sasha Dmochowski, MA is currently and American Ballet Theatre, she behind this specific issue. Fulvio received her BA in Psychology from makes an important contribution to pursuing a PhD in Clinical Psychology in Drew Anderson’s Weight and Eating Columbia University and an MA in the literature concerning recovery Disorders Laboratory at the University at General Psychology from New York from binge eating disorder by University.

Kamalamani continued from p. 58 through the lens of post-Reichian References character positions. She is a steering ecodharma, drawing upon her group member of the UK-based de Beauvoir, S. (2010) The Second experiences of being a development Psychotherapists and Counselors for Sex. Vintage. worker in sub-Saharan Africa, a lecturer Social Responsibility (PCSR) and editor Halse Anderson, L. (2014) Winter in International Development at the of its in-house journal, 'Transformations'. Girls. Marion Lloyd Books. University of Bristol, her current She co-facilitates Wild Therapy workshops with Nick Totton and The Metta Sutta. The original 'Metta meditation practice and being a child lost Sutta' can be found in the and found in nature. Her first book , meditation workshops based on her book. Meditating with Character, published in www.kamalamani.co.uk Suttanipāta (Sn 1.8) of the Pali 2012, explores engaging with meditation Canon. This particular translation is by Dharmacharini Vipassi.

Sengelmann References from pg. 63 Disorders, 92(1), 79-90. Lockwood, R., Lawson, R., & Waller, G. (2004). Faris, P. L., Hofbauer, R. D., Daughters, R., Compulsive features in the eating disorders: A Arcelus J, Mitchell AJ, Wales J, Nielsen S. VandenLangenberg, E., Iversen, L., Goodale, role for trauma? Journal of Nervous & Mental Mortality Rates in Patients With Anorexia R.L., Eckert, E. D., & Hartman, B. K. (2009). Disease, 192, 247-249. Nervosa and Other Eating Disorders: A Meta- De-Stabilization of the positive vago-vagal Mantero, M. & Crippa, L. (2002). Eating disorders analysis of 36 Studies. Arch Gen Psychiatry. reflex in bulimia nervosa. Physiology & and chronic post traumatic stress disorder: 2011;68(7):724-731. doi:10.1001/ Behavior, 94(1), 136-153. Issues of psychopathology and comorbidity. archgenpsychiatry.2011.74. Fogel, A. (2009). The psychophysiology of self European Eating Disorders Review, 10, 1-16. Briere, J. & Scott, C. (2007). Assessing of trauma awareness: Rediscovering the lost art of body Ogden, P. (2006). Trauma and the body: A symptoms in eating disordered populations. sense. New York, NY: W.W. Norton & sensorimotor approach to psychotherapy. New Eating Disorders, (15), 347–358. Company. York: W.W. Norton & Company. Chassler, L. (1997). Understanding anorexia Holzel, B. K., Carmody, J., Vangel, M., Congleton, O'Kearney, R. (1996). Attachment disruption in nervosa and bulimia nervosa from an C., Yerramsetti, S. M., Gard, T., & Lazar, anorexia nervosa and bulimia nervosa: A attachment perspective. Clinical Social Work S.W. (2011). Mindfulness practice leads to review of theory and empirical research. Journal, 25(4), 407-423. increases in regional brain gray matter International Journal of Eating Disorders, 20 Crow SJ, Peterson CB, Swanson SA, Raymond NC, density. Psychiatry Research: Neuroimaging, (2), 115-127. Specker S, Eckert ED, Mitchell JE. Increased 191, 36-43. Porges, S. W. (2007). The polyvagal perspective. mortality in bulimia nervosa and other eating LeDoux J. E. (2002). Synaptic self: How our brains Biological Psychology, Special Issue of disorders. Am J Psychiatry. 2009;166 become who we are. New York, Viking. Biological Psychology on Cardiac Vagal (12):1342-1346 Levine, P. A., & Frederick, A. (1997). Waking the Control, Emotion, Psychopathology, and Damasio, A. (2000). The feeling of what happens: tiger: Healing trauma. Berkeley, CA: North Health, 74(2), 116-143. Body and emotion in the making of Atlantic Books. Porges, S.W. (2011). The polyvagal theory: consciousness. New York, NY: Mariner Books. Levine, P. A. (2010). In an unspoken voice: How Neurophysiological foundations of emotions, Everill, J., Waller, G., & Macdonald, W. (1995). the body releases trauma and restores attachment, communication, self-regulation. Reported sexual abuse and bulimic symptoms: goodness. Berkeley, CA: North Atlantic New York/London: W.W. Norton & Company. The mediating role of dissociation. Books. Saxena, S. & Feusner, J. D. (2006). Toward a Dissociation, 8, 155-159. Kaye, W. (2008). Neurobiology of anorexia and neurobiology of body dysmorphic disorder. Faris, P. L., Eckert, E. D., Kim, S-W, Meller, W. bulimia, Purdue ingestive behavior research Primary Psychiatry, 13(7), 41-48. H., Pardo, J.V., Goodale, L., & Hartman, B.K. center symposium influences on eating and Schore, A. N. (2000). Attachment and the (2006). Evidence for a vagal pathophysiology body weight over the lifespan: Children and regulation of the right brain. Attachment & for bulimia nervosa and the accompanying adolescents. Physiology & Behavior, 94(1), Human Development, 2(1), 23-47. depressive symptoms. Journal of Affective 121-135.

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Kuhn continued from page 34 mechanism. Neuroimage, 84, 825-832. sadness or unhappiness in Canadian children. doi:10.1016/j.neuroimage.2013.09.041 Revue Canadienne De Sante Publique, 104 Evers, C., Adriaanse, M., de Ridder, D. T.., & (4), p. e322-e326. de Witt Huberts, J. C. (2013). Good mood Louis, P. & Flint, H. J. (2013). How our gut food. Positive emotion as a neglected trigger microbes influence our behavior. Journal of Sclafani, A. (2012). Gut-brain nutrient for food intake. Appetite, 68, 1-7. Neuroendocrinology, 25(5), 517-518. signaling: Appetition vs. satiation. Appetite, Doi:10.1016/j.nut.2013.02.006 71, 454-458.

Forsythe, P. & Kunze, W. A. (2013). Voices Luckose, F., Pandey, M. C., & Radhakrishna, Spring, B. (1984). Recent research on the from within: Gut microbes and the CNS. K. (2013). Effects of amino acid derivatives behavioral effects of tryptophan and Cellular Molecular Life Sciences, 70, 55-69. on physical, mental and physiological carbohydrate. Nutritional Health, 3(1-2), 55- doi: 10.1007/s00018-012-1028-z activities. Critical Reviews in Food Science 67. and Nutrition. Kroes, M. C., van Wingen, G. A., Mohajeri, Stillings, R. M., Dinan, T. G., & Cryan, J. F. M. H., Kloek, J., & Fernandez, G. (2014). McMartin, S. E., Willows, N. D., Colman, I., (2013). Microbial genes, brain & behavior: Food can lift mood by affecting mood- Ohinmaa, A., Storey, K., & Veugelers, P. J. Epigenetic regulation of the gut-brain axis. regulating neurocircuits via a serotonergic (2013). Diet quality and feelings of worry, Genes, Brain and Behavior, 13(1), 69-86.

Cotton continued from page 51 Practice, 18(6), 408-412. Pallaro, P. (Ed.). (1999). Authentic Movement: Grilo, C., White, M., Barnes, R., & Masheb, R. Essays by Mary Starks Whitehouse, (2013). Psychiatric disorder co- Janet Adler and Joan Chodorow: Essays American Pyschiatric Association (2013). The morbidity and correlates in an ethnically by Mary Starks Whitehouse, Janet Adler Diagnostic and Statistical Manual of diverse sample of obese patients with and Joan Chodorow (Vol. 1). Jessica Mental Disorders (5th ed.). Arlington, binge eating disorder in primary care Kingsley Publishers. VA: American Psychiatric Publishing. settings. Comprehensive Pyschiatry, 54 Roth, G. (1991). When Food is Love. New York: Davis, C. (2013). From Passive Overeating to (3), 209- 216. Plume, Pengiun Group. ‘‘Food Addiction’’: A Spectrum of Harlow, H. F. (1958). The Nature of Love. Rothschild, B. (2009). 8 Keys to Safe Trauma Compulsion and Severity. ISRN American Psychologist, 13(12), 673- Recovery; Take-Charge Strategies for Obesity, 2013. 685. Reclaiming Your Life. New York:W. W. Field, T., Schanberg, S., Kuhn, C., Fierro, K., Izydorczyk, B. (2013). Selected psychological traits Norton & Incorporated. Henteleff, T., Mueller, C., et al. (1998). and body image characteristics in Smith, B. W., Shelley, B. M., Leahigh, L., & Bulimic adolescents benefit from females suffering from binge eating Vanleit, B. (2008). A Preliminary Study massage therapy. Adolescence, Fall 33 disorder. Archives of Psychiatry and of the Effects of a Modified Mindfulness (131), 555-563. Psychotherapy, 1, 19-33. Intervention on Binge Eating. Fuller-Tyszkiewicz, M., & Mussap, A. J. (2008). Kristeller, J., Wolever, R. Q., & Sheets, V. (2013). Complementary Health Practice Review The Relationship Between Dissociation Mindfulness-Based Eating Awareness 2006, 11(133), 133-143. and Binge Eating. Journal of Trauma & Training (MB-EAT) for Binge Eating: A Tetzlaff, A., & Hilbert, A. (2014). [The role of the Dissociation, 9(4). Randomized Clinical Trial. family in childhood and adolescent Gallagher, M., Tasca, G., Ritchie, K., Balfour, L., Mindfulness. binge eating - a systematic review]. & Bissada, H. (2013). Attachment Levine, P. A. (2010). In an Unspoken Voice How Zeitschrift für Kinder- und Anxiety Moderates the Relationship the body releases trauma and restores Jugendpsychiatrie und Psychotherapie, Between Growth in Group Cohesion and goodness. Berkeley, California: North 42(1), 61-70. Treatment Outcomes in Group Atlantic Books. Wallin, D. J. (2007). Attachment in Psychotherapy. Psychodynamic Interpersonal McShane, J. M., & Zirke, S. (2008). Journal of New York: Guilford Press. Psychotherapy for Women With Binge Trauma & Dissociation Dissociation in Young, E., & Cooper, M. (2013). Applying a Eating Disorder. Group Dynamics: the Binge–Purge Cycle of Bulimia cognitive model to binge eating in a Theory, Research, and Practice. Nervosa. Journal of Trauma & female community sample. Eating Grilo, C., White, M., Barnes, R., & Masheb, R. Dissociation, 9(4), 463-479. Behaviour, 14(3), 295-298. (2012). Posttraumatic stress disorder in Ogden, P., Minton, K., & Pain, C. (2006). Trauma Zheng, H., & Berthoud, H.R. (2007). Eating for women with binge eating disorder in and the Body; a sensorimotor approach pleasure or calories. Current Opinion in primary care. Journal of Pyschiatric to psychotherapy. New York: W. W. Pharmacology, 7(6), 607-612. Norton and Company, Inc.

Israel continued from page 80 Israel. After retiring from professional competition, she became a psychotherapist specializing in domestic violence with offenders. “I assist people in understanding the importance of Diane is a professor in transpersonal psychology at Naropa being versus doing all the time. Stillness is our ally. Let’s University in Boulder, Colorado. She is also a senior counselor at learn how to meet ourselves with sprinkles of kindness and Women's Quest, a mind-body-spirit adventure camp for women compassion, it softens things.” and the co-owner of a Gyrotonic movement studio. A recovering athletic bulimic, Diane counsels people in physical, mental and spiritual integration. She has made it her mission to provide Diane Israel, PhD was a successful professional triathlete and strong support and guidance for others in the areas of body runner for 15 years. She was the 1984 Colorado mountain image, nutrition and rekindling life's passions and direction. running champion and a world-class racer whose achievements included winning the bronze medal at the Maccabiah Games in

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Colzato, L.S., Steenbergen, L., de Jacka, F.N., Mykletun, A., Berk, M., et free naturally: 7 weeks to Kwaadsteniet E.W. et al., 2013. al. (2011). The association between eliminating anxiety, despair, fatigue, Tryptophan promotes interpersonal habitual diet quality and the common and anger from your life. New York: trust. Psychological Science, 24 mental disorders in community- Random House. (12):2575-7. dwelling adults: The hordaland health study. Psychosomatic McGinnis, W. R., Audhya, T., Walsh, W. Davison, K. M., & Kaplan, B. J. (2012). Medicine, 73(6):483-490. J. et al. (2008). Discerning the Nutrient intakes are correlated with mauve factor, part 1. Alternative overall psychiatric functioning in Jackson, J.R., Eaton, W.W., Cascella, N. Therapies in Health and Medicine, adults with mood disorders. G., Fasano, A., Kelly, D. L. (2012). 14(2):40-50. Canadian Journal of Psychiatry, Neurologic and psychiatric 57:85-92. manifestations of celiac disease and Potocki, P., & K. Hozyasz. (2002). gluten sensitivity. Psychiatric Psychiatric symptoms and coeliac Hallert, C., Svensson, M., Tholstrup, J., Quarterly, 83(1):91-102. disease [article in Polish]. & Hultberg, B. (2009). Clinical trial: Psychiatria Polska, 36(4):567-578. B vitamins improve health in coeliac Kahn, R. S., Westenberg, H. G., patients living on a gluten-free diet. Verhoeven, W. et al. (1987). Effect Pynnönen, P., Isometsä, E., Aronen, E., Alimentary Pharmacology and of a serotonin precursor and uptake Verkasalo, M., Savilahti, E., & Therapeutics 29(8):811-816. inhibitor in anxiety disorders: A Aalberg. V. (2004). Mental disorders double-blind comparison of 5- in adolescents with celiac disease. Jackson, J. R., Eaton, W.W., Cascella, N. hydroxytryptophan, clomipramin, Psychosomatics, 45:325-335. G., Fasano, A., & Kelly, D. L. and placebo. International Clinical (2012). Neurologic and psychiatric Psychopharmacology, 2(1):33-45. Pynnönen, P., Isometsä, E., Verkasalo, manifestations of celiac disease and M., Kähkönen, S. A., Sipilä, I., gluten sensitivity. Psychiatric Kalaydjian, A. E., Eaton, W., Cascella, Savilahti, E., & Aalberg, V. A. Quarterly, 83(1):91-102. N., & Fasano, A. (2006). The gluten (2005). Gluten-free diet may connection: The association between alleviate depressive and behavioural Hudson, C., Hudson, S., & MacKenzie, schizophrenia and celiac disease. symptoms in adolescents with J. (2007). Protein-source tryptophan Acta Psychiatrica Scandinavica, 113 coeliac disease: A prospective as an efficacious treatment for social (2):82-90. follow-up case-series study. BMC anxiety disorder: A pilot study. Psychiatry, 5:14. Canadian Journal of Physiological Lake, J. (2007). Textbook of Integrative Pharmacology 85(9):928-932. Mental Health. New York: Thieme Ross, J. (2004). The mood cure: The 4- Medical. step program to take charge of your Freeman, M. P. (2010). Nutrition and emotions—today. New York: psychiatry. American Journal of Lara, D. R. (2010). Caffeine, mental Penguin. Psychiatry 167(3):244-247. health, and psychiatric disorders. Journal of Alzheimer’s Disease, 20 Torres, S. J., & C.A. Nowson. (2012). A Jacka, F. N., Pasco, J. A., Mykletun, A., (Suppl 1):S239-248. moderate-sodium DASH-type diet Williams, L. J., Hodge, A. M. et al. improves mood in postmenopausal (2010). Association of Western and Lehnert, H., & R. J. Wurtman. (1993). women. Nutrition, 28(9):896-900. traditional diets with depression and Amino acid control of Epub 2012 Apr 4. anxiety in women. American Journal neurotransmitter synthesis and of Psychiatry, 167(3):305-311. release: Physiological and clinical Washington Post 2014. Can What You implications. Psychotherapy and Eat Affect Your Mental health? Jacka, F. N., Pasco, J. A,. Mykletun, A., Psychosomatics, 60(1):18-32. http://www.washingtonpost.com/ Williams, L. J., Nicholson, G. C. et national/health-science/can-what- al. (2010). Diet quality in bipolar Lydiard, R. B. (2003). The role of GABA you-eat-affect-your-mental-health- disorder in a population-based in anxiety disorders. Journal of new-research-links-diet-and-the- sample of women. Journal of Clinical Psychiatry, 64(3):21-27. mind/2014/03/24/c6b40876-abc0- Affective Disorders, epub ahead of 11e3-af5f-4c56b834c4bf_story.html print, September 30. Maddock, R. J., Carter, C. S., & Gietzen, D. W. (1991). Elevated serum lactate Zang, D. X. (1991). A self body double- Jacka, F.N., Kremer, P. J., Berk, M. et al. associated with panic attacks blind clinical study of L-tryptophan (2011). A prospective study of diet induced by hyperventilation. and placebo in treated neurosis quality and mental health in Psychiatry Research, 38(3):301-311. [article in Chinese]. Chinese Journal adolescents. PLoS One. 6(9):e24805. of Neurology and Psychiatry, 24 Epub 2011 Sep 21. Mathews-Larson, J. (2001). Depression (2):77-80, 123-124.

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