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Teaching Life Skills to Reduce Disregulated Eating
By Karen R. Koenig, LCSW, MEd

Although there is a strong connection among genetics, brain chemistry, trauma, early family dysfunction, and disregulated eating, I have been struck by how often clients abuse food because they lack essential life skills. These skills are the universal set of behaviors we must master to maneuver through life successfully. By using a life skills approach in therapy, even small improvements make a large difference in a client’s relationship with food. The fact that they can learn skills is a relief and a comfort, enhancing motivation to change and reducing feelings of defectiveness, hopelessness, and helplessness. Moreover, clients must acquire these skills to improve their lives even if they don’t have eating problems.

Life Skills Lacking in Disregulated Eaters

All-or-Nothing Thinking

Disregulated eaters think in terms not only of fat or thin, starving or stuffing, or perfection or failure concerning food, but they also employ all-or-nothing thinking in almost every aspect of life. They must be loved by one and all or they’re certain they’re completely unloved and unlovable. They either rush off to the gym daily, even when they’re sick or tired, or stop for a day and then let their membership lapse and never step foot in the place again.

Teaching clients to see gray instead of black and white, find middle ground, embrace duality, hold mixed and contradictory feelings, and seek gradients in every aspect of life reduces all-or-nothing thinking. Until we point it out, many clients don’t realize how rigid and dysfunctional viewing the world only in black and white is. With our guidance, especially noting either-or thinking in therapy sessions and in the anecdotes they tell us about their lives, clients slowly start to observe and acknowledge small changes, come to view progress as more acceptable than perfection, and ease up on themselves as they begin to enjoy the richness of living between extremes.

The Need to Be Perfect

Yearning for and zealously courting perfection is based, in part, on all-or-nothing thinking. Disregulated eaters turn themselves inside out to look and do good, say the right thing, be the best, and shoot for perfection because they fear that if they do less, failure awaits them. Rarely do they consider doing something halfway, slapdash, or in a mediocre fashion. They believe that happiness rides on the coattails of perfection, that if they can only catch that brass ring, they’ll be able to hold on and never have to face shame or failure. Their standards are unreasonably high, and their fears of not being perfect are driven by a generally unconscious terror of shame.

Encouraging clients to risk and experiment with imperfection, mistakes, and failure pushes them to confront their fears. Learning how to fail well is as important as learning how to succeed, but how many clients are taught how to take a dive with grace, collapse with dignity, or fall down, dust themselves off, and get back up? It helps them to see us handle our foibles lightheartedly and with self-compassion—when we’re late for a session, forget crucial information they told us, or simply have had a bad day. Our job is to teach them about self-love that isn’t contingent on doing but on being, a mindset of unconditional approval that is rooted in ongoing self-regard no matter what.

Difficulty Managing Stress and Internal Distress

Clients eat emotionally to manage stress. There is a correlation between people who do too much and eat too much. Overly nice men and women take care of and try to please others at the expense of themselves, feel guilty and inadequate when they say no, have impossibly lofty standards for themselves, and possess minimal capacity for tolerating emotional discomfort. Whether by nature or nurture (or likely a combination), they easily become overwhelmed and self-care stops, except for seeking food, mostly carbohydrates that help them relax and unwind.

The more we help clients acknowledge, identify, experience, and express emotions appropriately, the less inclined they’ll be to turn to food when stressed or distressed. Focusing on extreme self-care, self-soothing, and self-expression teaches clients that there are far better ways to care for themselves than heading for the refrigerator. For trauma survivors, adjunctive therapies such as EMDR and DBT are enormously helpful in disempowering painful memories.

Poor Self-Regulation

Impaired self-regulation is practically synonymous with eating problems. Clients are as likely to let themselves become ravenous as to go overboard with food. They have what I call an “enough disorder”; that is, they don’t know what is too much or too little in many aspects of their lives and suffer ongoing, anxiety-provoking doubts about sufficiency. They’re reactive rather than reflective and responsive and bounce through life as if attached to it by an emotional bungee cord.

With these clients, it’s important to point out each instance in which they’re acting on impulse only and not using sound judgment. The more they understand their impulsive motivations and focus on intentional, as opposed to reactive, behavior, the
greater the likelihood of their finding a comfortable middle ground with food. Alternately, practicing with food—what’s too little, too much, enough?—will help them gain a sense of sufficiency and adequacy and teach them that by knowing and listening to themselves, they can take charge of balancing behavior.

Difficulty Relaxing/Playing

Not only do disregulated eaters have difficulty unwinding, but their lives are often bereft of activities that aren’t task oriented; that is, they don’t know how to play. Many are relentlessly goal oriented, view activities that are creative and playful as useless, or “play” in such a way that feels more like work because they have unreachable standards and are afraid of failure. Food abuse becomes a substitute for play, a way to lose oneself in the moment, blot out consequences, and enter a magical world where there is no yesterday or tomorrow and nothing matters but now.

Encouraging clients to develop play skills goes a long way toward freeing them from harsh egos and the passionate pursuit of perfection. When they learn to play, they have less need to use food to “go unconscious.” Moreover, getting into a state of flow through play helps them relax and be carefree, a state that is exactly what they’re seeking in food abuse.

Poor Self-Care

Clients with food problems may not appear to have poor self-care, but they often do. When the therapist digs a little, she finds that they fail to have medical checkups, are careless about taking vitamins or medication, drive without a seat belt, or refuse to spend money on items that are necessary to their health and well-being. Food is just another area in which they mistreat themselves. Without the life skills of ongoing self-care, they will continue to abuse food and their bodies.

When teaching clients to take better care of themselves, it’s important to consider their physical, mental, emotional, and spiritual (if a client is so inclined) well-being. Physical care involves everything from dealing with health concerns to wearing clothes that fit and are comfortable. Mental care includes keeping the brain active and challenged and valuing ongoing learning. Emotional care entails being able to identify, experience, contain, and express a complete range of feelings appropriately. Spiritual care involves finding meaning in life, though not necessarily through religion.

How to Use a Life Skills Approach
Therapists can use two approaches to teach life skills: integrate skill learning throughout therapy or present it as a discreet module of learning and practice. Clients can rate themselves on life skills at the outset of this work and at regular intervals to determine how they’ve changed (reinforcing incremental rather than all-or-nothing thinking). With them, we can brainstorm irrational beliefs and obstacles that inhibit growth and change. It’s also helpful to provide clients with homework assignments that include targeting one or a few life skills and review progress regularly.

Therapists can encourage clients to practice the following food-related behaviors to encourage learning life skills:

• Eat when moderately hungry and stop when pleasantly full or satisfied.

• After overeating, don’t starve but wait until moderately hungry again to eat.

• Find enjoyable activities that promote “flow” without worrying about consequences.

• Instead of eating, practice relaxation techniques when upset.

• Find a middle ground rather than be rigid and purist about food or disregard nutrition completely.

• Engage in excellent medical, emotional, mental, and spiritual self-care.

• View overeating and bingeing “relapses” as opportunities for life skill learning.

As clients gain life skills, they’re setting the stage for giving up unwanted eating. By acquiring greater ability to manage life, they are able to reach a point where food abuse no longer serves them and, therefore, becomes unnecessary. Once they find more effective ways to cope with life, our job is to help them see how they’ve grown, then say good-bye to maladaptive eating patterns and hello to a happier, more satisfying future.

— Karen R. Koenig, LCSW, MEd, is a Sarasota, FL-based therapist, a national speaker, an international author, and an expert on the psychology of eating. Her fourth book, Nice Girls Finish Fat — Put Yourself First and Change Your Eating Forever, was released in June.