Intrinsic motivation is the first step

For many years I’ve been working young women with Anorexia Nervosa. Many professionals have asked me what the role of mindfulness might be in this very specific healing process. There is hardly any research done in this field. so I’ve tried to summarize my approach in different steps.

Identifying the readiness

The first step is to inquire the level of motivation. Prochaska and DiClemente have developed 6 stages of change to identify “readiness”. For example, a young girl with anorexia is referred by her medical doctor but doesn’t perceive her behavior as problematic. People in this ‘pre-contemplation stage’ are hard to treat because there is no intrinsic motivation for wholesome action in the near future. It is only in the next stages where people begin to recognize that their behavior is problematic. Only at that point, a mindful eating program might be effective.

Besides identifying the stages of change, understanding the psychopathology behind every kind of disturbed eating behavior is part of the good practice. My experience tells me that the best results can be noticed when ‘mindful eating’ is imbedded in a larger integrative approach with other health professionals, especially in the case of anorexia.

Stabilizing the mind

When working with anorexia, I will always start with what I call, “stabilizing the mind”. With anorexia, the judgmental mind has taken over and the physical sensations in the body are often completely overruled by the killer critic. I’ve noticed that general mindfulness exercises with the body as focal point can enhance their inner stability. Some examples: basic mindful breathing exercises, mindfulness of body parts in contact with the chair while sitting, mindfulness of the feet in contact with the floor while walking or standing (mountain pose).

Responding with kindness when there is fear

Compassionate health care

In research findings, it is known that the primary reasons for dieting are not based on a desire to be thin (‘thinspiration’) but on a fear of gaining weight. An important nuance. It is anxiety and not desire which is the driving force behind the restrictive eating behaviour. This understanding will it make easier for the health professional to feel compassion for their clients instead of judgmental questioning weight and food intake. The embodiment of kindness by the therapist has been proven to be one of the most effective mirrors to question the harsh relationship people with eating disorders have with themselves and their bodies. 

Cellular hunger

It is often a misconception that people with extreme restrictive eating habits never have moments of binge eating. These binges almost naturally occur as a result of food restriction when the nutritional needs of the body are depleted. The cellular needs of the body will then overrule the anorectic thoughts, sadly often combined with a punishing mindstate. However, I’ve noticed that individuals with anorexia have an excellent sense what the cells of their body crave for… if they are ready to listen with a free mind and a calm heart.

Self-inquiry

In a customized program for AN, we challenge the anorectic voice by asking “Are you sure?” or “Is it true, can I absolutely know that this thought or belief is true?” After a while it is possible to listen to any of those blaming thoughts of the anorectic voice without the need to follow blindly its irrational  rules. The mind is capable to discern what is wholesome and what not and opens up for other kinds of information. And if the mind relaxes, then also the heart will become more receptive for wise, compassionate care and the joy of eating. In fact, “anorexia” becomes their greatest teacher.

In the absence of defensiveness, love and gratitude is all that’s left.

Caroline Baerten, Belgium

What is your experience with AN and mindfulness?

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