Mindfulness for Eating Disorders, Overeating and Obesity

Mindfulness for Eating Disorders, Overeating and Obesity

• 1.
  Mindfulness for EatingDisorders, Overeating and Obesity Douglas Ziedonis, MD, MPH
• 3.
   Only 8Research Studies, including different approaches to Mindful Eating (MBI, DBT, ACT, CEBT, CBMI, etc)  All non-randomized and without a control group  All relatively small sample sizes – Leahey et al., 2008 – Cognitive-Behavioral Mindfulness Intervention (CBMI); N=7 – Proulx (2008)- Mindfulness-Based Intervention (MBI); N=6 – Safer et al. (2007) – Dialectical Behavior Therapy (DBT); N=1 – Corstorphine (2006) – Cognitive-Emotional-Behavioral Therapy (CEBT); N= 1 – Baer et al. (2005) – Mindfulness-based Cognitive Therapy (MBCT); N=1 – Heffner et al. (2002) – Acceptance and Commitment Therapy; N=1 – Safer et al. (2001) – Dialectical Behavior Therapy (DBT); N=1 – Kristeller et al. (1999) – Mindfulness-Based Intervention (MBI); N=18  Application of mindfulness-based treatments is becoming more common in clinical practice; however empirical evidence on efficacy is still needed
• 4.
   Assess forAddiction –What are the trigger foods / situations / behaviors  Understand the Craving (obsessions), Binging (compulsions), and Stinking Thinking  Denial, minimization, and rationalization – PhysicalAddiction – tolerance and withdrawal  What are the immediateAbstinence Goals?  Food Plan / Monitoring  What are the long-term Recovery Goals? – Stage I, II, and III - personal responsibilities & plan – Fellowship and Support  Disease of Isolation – Alternative healthy highs & healthier choices  Check for Psychiatric Co-morbidities – Depression and Sweet Cravings  Public Health Orientation – Role of Marketing / Culture Change / Drug Dealers, etc
• 5.
   “The awarenessthat emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment” – Jon Kabat-Zinn
• 6.
  1) Self-regulation ofattention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment. – Body sensations, Feelings, &Thoughts 1) Adopting a particular orientation toward one’s experiences in the present moment, characterized by curiosity, openness, and acceptance. – Compassion Bishop 2004
• 7.
   Mind andhealth: Developing a neural marker for mindfulness, a pathway to health. (NCAM; PI: C. Fulwiler; Co-I: D. Ziedonis) – Using MRI to characterize changes in neural circuitry of emotion regulation and relationship to recovery from obesity.  Amygdala connectivity correlates with mindfulness (reduced amygdala volume & increased hippocampus volume)  Decreased Default Mode Network activity during meditation
• 8.
   Present momentvs Mindless Eating – Slow down - “Raisin Exercise” – Attend to Body, Emotions, Thoughts – Avoid self-judgment  Many Models: MBSR, MB- EATS, DBT, ACT, etc.  Linking with Spiritual Health
• 9.
  Jean Kristeller, Ph.D.,Professor of Psychology, President/Co-Founder, The Center for Mindful Eating, Indiana State University Kristeller & Wolever (2011) Eating Disorders 10-week course Used in the treatment of binge eating disorder, compulsive eating, depression, weight loss, etc. Blends mindful eating exercises, CBT, MBSR, and general mindfulness meditation practice “Mindful eating” exercises – e.g.,  Tune into body’s signals – become aware of physical hunger & notice fullness  Chew slowly and savor your food  Observe the sensory experience of taste  Mindful food choices Mindfulness meditation practice (general self-awareness, -acceptance, and – compassion; and emotional regulation)
• 10.
  8 week program(2.5 hrs / week) & 6 hour weekend retreat Explore mindfulness practice & discussion of topics related to stress in daily life (50%) Living on automatic-pilot Learning to stop Coming back to the breath Relationship of stress to illness Problem focus and emotion focus coping Assertiveness in communications Learn Formal & Informal Practices (50%) Homework
• 11.
   Formal Practicesof Meditation & Gentle Yoga Exercises: – Ex: Awareness of Breathing, Sitting Meditation, Slow Walking Meditation, Body-scan, Raisin Exercise (mindful eating), Gentle Yoga Exercises, Mountain/Lake Meditation, Loving-kindness Meditation, etc • Informal Practice: many opportunities all day to enhance awareness: – Any moment – perhaps when you catch yourself being mindless and gently redirect to the present moment – Consciously increase awareness to current thoughts, feelings, & body sensations  How the weather affects us physically – Pleasant experiences & unpleasant experiences – Reactivity to stressful situations or events – While communicating with others  Homework – Consider journal / log of your experiences.
• 12.
   Albers, S.(2008). Eating Mindfully: How to End Mindless Eating and Enjoy a Balanced Relationship with Food. New Harbinger Publications, Inc.  Bishop, S. R., Lau, M., Shapiro, S., Carlson, L.,Anderson, N. D., Carmody, J. . . Devins, G. (2004). Mindfulness:A proposed operational definition. Clinical Psychology:Science & Practice, 11(3):230-241. doi:10.1093/clipsy.bph077  Chozen Bays, J. (2009). Mindful Eating:A Guide to Rediscovering a Healthy and Joyful RelationshipWith Food. Boston, MA: Shambhala Publications, Inc.  Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology:Science & Practice 10(2): 144-156.  Kristeller, J. L., &Wolever, R. Q. (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eat Disord,19(1),49-61.doi: 10.1080/10640266.2011.533605  Nhat Hanh,T. & Cheung, L. (2011) Savor: Mindful Eating, Mindful Life. Harper One.  Wanden-Berghe, R. G., Sanz-Valero, J., &Wanden-Berghe, C. (2011).The application of mindfulness to eating disorders treatment: a systematic review. Eating Disorders, 19, 1.