Sunday, August 31, 2008

Binge No More by Joyce Nash (Pt 2)

The second part of this book begins with a chapter full of blank logs and questions for monitoring and analyzing your eating behavior. I won't be putting them here, but the log is very similar to Fairburn's.

Nash introduces the ABC Model of Behavior, to help identify when binges are likely.

Antecedents - the events and feelings that lead up to a binge
Behavior - the binge itself
Consequences - what happens after the binge

So, when monitoring your eating in the log, you would look for patterns in the A and C areas that will point out when and why your binges are likely to happen.

On this log, you include:

time of day
foods eaten
indicate whether you feel it was a binge
degree of hunger you felt before eating
where you were/what you were doing while eating

Nash provides a 21 item questionnaire for analyzing your logs. It looks at how often you binge, what may have triggered the binges, your thoughts and decisions made leading up to and during the binge. You're asked about consequences (both positive and negative), the types of foods you eat during the binge, and when and where you binge. Using your records and the questionnaire (do the analysis every week or two), you can determine which of the following is causing your binges:

seeking gratification
problem thinking
lack of consciousness
poor nutrition

So, now it's time to take action and change how you eat. Most of us bingers are also dieters, through not eating, restricting calories, or avoiding certain kinds of foods. In more extreme cases, some may use laxatives, diuretics, OTC diet pills, or exercise excessively to compensate for the caloric intake. This is the part of the self-help where we stop doing these things and start taking control over the forbidden foods.

Nash suggests introducing the forbidden foods a little at a time. Rather than having an all-or-nothing viewpoint, look at the foods on a continuum that allows you to make some not so great choices now and then. As often as possible, choose better foods, but don't ever consider something off limits.

This is where I run into problems, as a low carber. Nash recommends using the Food Pyramid to guide your choices, but this is so hotly debated among the different camps that I'm not even going to touch it here. I am not qualified in any way to say "do follow the food pyramid" or "don't follow the food pyramid" because it all depends on your own viewpoint regarding carbs, protein, and fat. There are the obvious things I agree with: occasional sweets and baked goods. But there are others on the list provided that I disagree with, just because I have history with lower carb diets. Should we stuff ourselves with peanut butter or ground pork or bacon or hot dogs? No, I don't think so, but I don't think they belong in the "Seldom" category. I eat bacon quite often. Sure, it's turkey bacon, but it's still bacon. I occasionally have peanut butter and pork. I do prefer to focus on some of the leaner diary and protein sources, but that doesn't mean I think we should all live on egg whites, skim milk, and spinach.

I also disagree with the number of servings given on the food pyramid - really, 6 to 11 servings of grains and cereals? I'd love to eat 11 cups of Cheerios a day, but I don't think that will help me at all. Vegetables, you can never go wrong with those, so I have no problem with the 3 to 5 servings recommended. Fruits, 2 to 4 servings, I'm not a big fan of fruit, but I suppose the quantity of fruit I eat in one or two sittings would fit (or maybe even exceed that some days). Dairy, 2 to 3 servings, sure. Protein, 2 to 3 servings, I don't agree with that one. Body for Life and Burn the Fat, Feed the Muscle, and all the other muscle-centric stuff I've read suggest protein with every meal, especially if it has a starchy component. Something about slowing the absorption or whatever - I can never remember details. Fats, oils, and sugars used sparingly, okay, I am mixed on this one. I prefer moderate use of good fats and oils. Sugar, I definitely try to avoid that!

Enough of my commentary - back on topic. Here are Nash's suggestions for normal eating. They sound a lot like Fairburn's suggestions.

Eat 3 meals and 2-3 snacks per day, preferably at a set time.
Eat every 3-4 hours.
At first, focus on eating at the right times, rather than what you eat.
Never skip a meal.
Only eat when planned.
If you do mess up, get back on track as soon as you can.
Once you establish your time pattern, begin to intodroduce healthier foods.
Don't diet by not eating, restricting calories too much, or restricting food groups or specific foods.

It might seem counter-intuitive to not restrict when you're trying to lose weight, but like Fairburn, Nash suggests that structured eating with healthy choices can actually lead to weight loss. Eating regularly will decrease hunger, and you'll be less likely to binge on the foods that actually do make you gain weight. Having set times to eat reduces the opportunity for grazing. Keeping a schedule of 3-4 hours also keeps your metabolism up and stabilizes you mood, reducing the negative feelings that often trigger binges.

What about cravings? I remember earlier this summer, I wanted ice cream so badly. Nothing I did made that desire go away. It persisted all day long. I can't remember now if I actually had ice cream, but I think I managed to stay away. To deal with cravings, Nash suggests following your schedule, don't think of something as a bad food - think of it as something you should limit, and try to catch the craving early (leave the area of temptation if you're around the food that you're craving, focus your attention elsewhere, or disrupt your senses by brushing your teeth, chewing gum or a mint, or smelling something strong). Have a list of alternatives to eating available. Remember the list of activities Fairburn suggested keeping with you at all times? Apparently a good strategy. If you really can't resist, go ahead and have just a little. (Of course, if you don't have issues with portion control, this is just fine. But I can never stop at just a little bit, so it's a big issue for me.) If you do indulge, do it without guilt. Guilty feelings lead to self-loathing, which leads to more binges. When you want something, give yourself 10-15 minutes to see if the desire passes. If it doesn't, try one of the alternatives mentioned above. Determine how important giving in to your craving is and decide how much you should eat. Then eat it and stick with your plan.

If you've been sticking to your plan, reward yourself. Use a star/sticker chart to illustrate your ups and downs. Set up a reward system. For example, no binges in 2 weeks, buy yourself a CD or a DVD. Don't punish yourself for not meeting a goal though! You don't need to be perfect. Be consistent instead, with the number of binges decreasing over time.

In order to change your behavior, you have to change how you think. We often make mistakes with our thought processes. We adopt all-or-nothing mentalities, or rely only on our emotions that are often negative. We overgeneralize the way we eat and/or look. We see doom and gloom in the future, or think we know how others view us. All of this negativity sabotages our efforts not to binge, and we all have these voices in our heads:

The Critic - the judgmental voice that chips away at our self-esteem
The Excuse-Maker - the coping voice that justifies your behaviors (boy, this is a big one for me!)
The Worrier - the voice that predicts disaster, that you'll get fat if you eat that potato chip
The Caretaker - the voice that puts our own needs on the back burner in favor of the needs of others
The Victim - the voice that says it's unfair to be afflicted with these problems (yeah, another one I'm guilty of - I've noted my resentment often, that I can't just eat what and when I want)
The Enforcer - the voice that cracks the whip and demands perfection in our eating and exercising
The Voice of Negativity - the voice that points out all your flaws
The Voice of an Eating Disorder - the voice that tells you "this is who you are and how it is" when it doesn't need to be that way

Nash provides a work sheet for identifying what your voices are telling you. You use this work sheet to reprogram your brain to become a more positive thinker. Nash suggests using index cards to write out positive thoughts. You could use anything - Post-It Notes, a computer program to send daily reminders, whatever. Post something positive in your blog every day. Find something every day, or as often as you need it, to remind yourself that you are not all of those things the negative voices say.

Nash also has a chapter dealing with body image, including a bunch of questions about how you perceive your body during various periods of your life. I'm not going to review specifics here because, quite frankly, it's hard for me to relate to any of it. I think my view of my body shape and size is very realistic, and it's not that I'm ashamed of my body in any way. Yes, I tend to keep it covered because really, no one should see that ghost white skin and stretch marks. I think my body size and shape goals are also realistic - I don't want to be thin. I want to be curvy and muscular. I think here are some parts of my body that look pretty darn good (I love my legs - they may be short, but I can see muscle and I think they curve in an appealing way. My husband loves my legs and never hesitates to tell me!)

Coping with disordered eating is an entirely different beast for me. Nash talks about problem-focused coping and emotion-focused coping. Problem-focused coping uses problem-solving strategies and other active methods of change that can influence a situation. I suck at problem solving. I'm not an outside-of-the-box thinker at all. In fact, even obvious solutions are often a mystery to me. Emotion-focused coping occurs when there isn't much about a situation that can be influenced, including negative feelings. For the disordered eater, this results in avoidance and escape.

Nash's strategy problem-focused coping looks a lot like Fairburn's:

Define the problem
Generate a list of alternative activities
Choose a solution and execute it

Fairburn's strategy is a little more complicated (off the top of my head, I recall a step that requires we consider the consequences of each possible alternative), but I think either one can be a good starting point.

Nash's strategy for emotion-focused coping involves relaxation and deep breathing:

Imagine a relaxing scene
When you're relaxed, end the imagery
If you want, pre-plan your imagery (even write it down) - I do this!! Well, I pre-plan the dreams I'd like to have when I fall asleep. Same concept. Yes, I'm weird.
Practice imagery. I do this too. I pre-plan the dreams several times a day. This is probably why I get so little done around the house.

There's more in the book's remaining chapter and a half that I just cannot properly summarize. There's a bit of psychology involved and I could just not do justice to any kind of write-up. I've covered the bare bones of both books here in my blog anyway, and if you think you may have binge eating disorder, I highly recommend either (or both) books. I'd start with the Joyce Nash book (Binge No More: Your Guide to Overcoming Disordered Eating) and if you feel you need more, get the Christopher Fairburn Book (Overcoming Binge Eating).

1 comment:

Jess said...

Wow, Becky! This is really interesting stuff! Thanks for the summary and it is definitely some good food for thought...