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14 posts categorized "Relapse"


Getting into an Active Mindset

A quick reminder that before you start any new physical activity, it’s essential that you have a physical examination and get clearance from your doctor. This is critically important and must be taken seriously.

Along with a physical check-up, you also want to do a mental check-up in order to get into an active mindset. The first shift you might need to make is with the language you’re using. If the word “exercise” has negative associations for you, simply replace it with “physical activity,” “healthy movement” or another term of your choice.

You might also need to let go of some false beliefs or other forms of distorted thinking about exercise, such as all-or-nothing thinking (“I missed my walk today, so I might as well forget about doing anything else”), disqualifying the positive (“I was late and only did half the yoga class – that doesn’t count”) and should statements (“I should be able to walk as fast as her”).

Aside from the amazing benefits that we’ll discuss more next week, healthy movement can also protect you from the impact of a sedentary lifestyle. An October 2012 study in the British Journal of Sports Medicine, as reported in the New York Times, found some serious health risks of being sedentary, including diabetes, cardiovascular disease and premature death.

So next, update your expectations of what counts as “real” physical activity. I like to remind my clients that when it comes to healthy movement, something is something. You don’t need to jog, lift weights or do anything you don’t want to do, especially in the beginning.

Your goal is to do less nothing (sedentary, passive activities like working at the computer or watching television) and more something (active tasks that get you moving around).

The next thing to get clear in your mind is: Are you ready to start an activity program? If not, you’ll be on an uphill journey the whole way. One way to think of it is to consider where you are in the five stages of change: precontemplation, contemplation, preparation, action and maintenance.

If you’re not in the action stage yet – be honest – then ask yourself what you need in order to get there. Maybe it’s professional help, like a therapist, life coach or personal trainer. Maybe it’s personal help like a healthy movement buddy.

Once you’re in action, staying motivated can sometimes be even trickier. We’ll talk more about specific activities next week, but for now I’ll just tell you that I have to mix things up in order to stay motivated, e.g., yoga and walking my dog. I know I would burn out from doing just one thing.

Consider now what might derail your efforts and plan ahead for how to handle those things. For example, if a rainy day ruins your plans for a walk, maybe you could have a playlist or CD handy of some songs you like to dance to.

It’s just like if you relapse with your food behaviors – if you miss a day, or even a week, just pick up and get back on track when you can.

Even if you’ve been told not to exercise for a period of time, you can include “rest” in this phase of your activity plan, and approach it with the same discipline as any other goal. You will still be in the mindset of carrying out your physical treatment plan.

Next week, we’ll talk more about specific activity ideas – what to do and not to do.


Learning to Live in Recovery

According to the Transtheoretical (Stages of Change) Model developed by Prochaska and DiClemente, once someone has passed through the active stage of recovery they enter a maintenance phase. As I wrote about in 2009, a big area of focus in this stage is on how to prevent relapse.

But there has to be more to life than just the absence of your eating disorder. Otherwise it's still controlling you and your life. I encourage people to learn how to live in recovery, to build a life where you're dealing with the realities of preventing relapse, but also open to new discoveries and growth beyond what you've ever imagined for yourself.

The truth is that the stages of change and recovery are fluid, and you will move back and forth between them. Part of the challenge is that life will continue to throw stressors and unpredictable things at you – the difference is that now you're not using food or eating behaviors to deal with them. That may seem scary, but it's actually really great.

Imagine just how proud you'll feel the first time get through a tough time on your own – without the old crutches that you used to use. It doesn't mean you're doing it alone, it means you're reaching out for help in a healthy way, from healthy people, and you're receiving and using that help.

Living in recovery requires a totally different way of being. At the White Picket Fence Counseling Center, we talk about this with our clients right from the beginning, so they can practice the tools they can tap into later. Otherwise, they may not know how to handle it when, let's say, people stop noticing or commenting on their new healthy body weight, or when it's time to replace their mealtime habits of calorie counting or deprivation.

We pride ourselves on equipping our clients with the tools, confidence and self-assurance to be strong in their recovery, and to be aware of potential issues so they can talk about them instead of reaching for old, unhealthy behaviors. We remind them, "This too shall pass," and it always does!

Life in recovery brings the chance to develop healthy relationships with food, with your body, with yourself, and with others. When you're using food behaviors, if you have a problem, then automatically you have two problems. In recovery, when you have a problem, you have one problem, and infinite tools and resources to solve it. That is true freedom.

At the White Picket Fence Counseling, we will be continuing our series of Recovery Stories in the Living Room events, where clients share about their journey to recovery. We're looking for volunteer speakers for this series. Please contact us today if you would you like to share your story. We'll also be doing some specialized workshops on this topic, so stay tuned for details. In the meantime, watch the blog and newsletter for additional articles about tools, resources and relationship guidance for the recovery stage.


When People Are the Triggers

In the recovery process from an eating disorder, you'll probably start by focusing on the food and your eating patterns. Once you've worked on those things, it will be time to turn you attention to your relationships – your emotional triggers.

You may feel triggered when people start talking about weight, dieting, the newest exercise program or the foods they're eating or not eating. Well-meaning friends and relatives may ask questions about what YOU are eating or not eating, or they may comment on your appearance.

Shopping for groceries or clothing can trigger many different issues around food and weight, and food is on display pretty much everywhere you go at certain times of year like the winter holiday season. Just seeing those huge quantities of food all in one place can be terrifying for someone in recovery from food addition, emotional eating, anorexia or bulimia.

Relationship issues can pop up just as often, where TV commercials, books or other people in your life can remind you of painful situations that are still unresolved. Sometimes you can get caught off guard by a reaction that feels out of proportion, like getting really upset about someone you don't even know.

When someone triggers you, usually it's because somewhere deep down it reminds you of an interaction with your family of origin. This is another reason that we welcome triggers in the therapy process. This is a great opportunity to work through something that you wouldn't have otherwise. 

You don't have to be afraid of triggers. You can learn to understand them and deal with them – not eat over them.



Use a Pen to Fight Your Triggers

One of the most helpful tools in 12-step recovery programs is the daily written inventory of what you did well that day, where you could improve, and if there is anything you need to set right with an apology or other action.

This practice can be extremely useful when you're learning how to cope with "triggers" – people, situations or foods that create an emotional response. For people recovering from anorexia, bulimia, food addiction or emotional eating, the first response to being triggered is to use their unhealthy eating behaviors.

By keeping a written record of what triggers you and bringing that to a therapy session or group, you can ask for help to learn how to change your default response and develop healthier coping mechanisms.

A therapist can take you through a role play where you actually rehearse what you will say or do differently the next time that situation comes up. You may also spend time looking deeper into what it is that triggered you in the first place. That awareness can be an important element of the healing process.

Your therapist can help you create a physical symbol of recovery so you can focus on that object until the trigger passes. I've known people to use a picture created in a therapy session, a stone or shell, a word or quote, a medallion or jewelry or even a pen with their name on it. This transitional object can effectively bridge the gap between the work done with the therapist and the triggering stimuli that takes place in everyday life.

The scariest thing about triggers is anticipating them. The first step towards gaining control over them is to capture them on paper and bring them down to size. Right then – triggers begin to lose their power.


Let's Get Triggered

For people with an eating disorder, emotional eating or food addiction, the holidays can be like a minefield of "triggers" – situations or foods that bring heightened anxiety and awaken the compulsion to use unhealthy eating behaviors.

Earlier in my career, I had been trained from the perspective that we shouldn't mention triggers or specific foods in therapy, in case someone would leave their session and binge, purge or restrict themselves right into relapse. Today things are different. It's not that we would ever purposefully provoke someone, but we know that triggers happen out in the world we live in.

Now, if someone is triggered, we know that she or he can come back and discusses that in a future session with the therapist or group. That way we can equip the person with valuable tools for handling similar situations in the future.

By trying to protect my clients from their triggers, I was actually denying them that chance to grow beyond them. Research, as well as my own clinical experience, has taught me that it doesn't help to avoid the triggers in therapy – and it's certainly not therapeutic.

My approach has changed and grown, just as my clients have. It's okay to be triggered in group or in therapy, as long as you process it, like we do here at the White Picket Fence Counseling Center. Whether that happens immediately, or whether you need to think about it and come back, it's important to look at what is happening.

I would even say that today we welcome triggers, and that's because there are certainly going to be triggers out there, especially during the holidays – in the grocery store checkout line, at the gas station and in conversations with friends, family and co-workers. The goal is to not only tolerate these triggers but to embrace them with no thoughts or feelings of hurting yourself.



You Can't Lie to Your Journal

In a previous article, I wrote about how journaling can help you choose the right tools for your recovery. Of course journaling is a powerful tool in its own right. It's very difficult to lie to yourself when you're writing. There's something about putting pen to paper that always brings out the truth.
If you've been getting complacent with your recovery, your journal will start to reveal if you're headed towards relapse. Here are a few suggestions to make sure you get these important messages:
  • Keep writing, even when you don't feel like it. Start with "I don't feel like writing today..." and see where it takes you.
  • Read your journal entries to your therapist, support group or a trusted friend or family member. You'll get an outside perspective and they may recognize the warning signs before you do.
  • Re-read your own entries. You may see patterns, such as more negative thoughts or particular issues coming up day after day.
For additional free journaling tips, download the Therapist at Home e-book from our website. You may also benefit from the spirit of change 21-day journaling course. A new lesson is delivered by email every day for 21 days, but you're welcome to go at your own pace.
As we learned from Beth's story, even when you're doing many of the right things in your recovery, relapse can sneak up on you – especially if you're lying to yourself about what's going on. Keep talking to your journal and the truth will come out.



Upcoming Groups and Workshops - New Starts and Ideas

Upcoming Groups and Workshops will help you get a jump start in your personal growth process.  Click here to view and download your own printable copyTell us what you think of the new workshops - let us also know what interests YOU!


The Danger of Easy Recovery – Beth's Story

Beth (not her real name) had been recovering from a compulsive eating disorder for eight months. She visited her therapist once a week, attended 12-step program meetings, and wrote diligently in her journal every single evening. She was gaining more confidence eating in public settings, and was usually able to speak up and ask for what she needed, whether that was specific foods, or extra support.
Things were going so well that she didn't want to rock the boat by paying too much attention to a few niggling thoughts in the back of her mind. For example, she was feeling really nervous about starting a new role at work. Sometimes when she started thinking about it, her thoughts would spiral down until she felt so low she wondered if an extra helping at dinner or a sweet treat might make her feel better.
She'd heard the word "relapse" and the idea terrified her. So much that she didn't even want to mention her worries to her therapist or anyone else in her support network. She thought that talking about it might make it happen. She was probably just being dramatic.
Two weeks later, Beth was in a full-blown relapse, wondering, "How did this happen? Things were going so well!"
At the White Picket Fence Counseling Center, we hear from many people who let their guard down and then fell into a relapse situation.
You never actually "graduate" from a recovery program, because life will continue to present new challenges that you must go through without sinking back into your compulsive behaviors. But you can pursue more intensive "graduate-level" recovery activities.
Your goal is to constantly strive for your next level of recovery, and to always be on the lookout for anything that could threaten your new way of life.
Learn from Beth's experience – talk about your troubles and don't stop working on your recovery. That way you can avoid relapse before it starts.


10 Ways to Take Your Recovery to the Next Level

StairsWhether you're just starting to address your food issues, or you've already had some healing from eating disorders and food addiction, there is always a next level of recovery to be reaching for.
The truth is that if you get stuck in a rut in your recovery, it puts you in real danger of relapse. It's crucial to keep taking actions and work constructively on finding new solutions to your daily issues – because life will always bring new challenges.
"90 in 90" is a technique that people in 12-step programs use – they attend 90 meetings in 90 days, striving for one meeting per day (but sometimes doubling up). This method of enveloping yourself in recovery has a powerful impact. If you're new, it's an intense introduction to the 12-step way of life. If you're floundering, it's a fresh infusion of experience, strength and hope for dealing with the struggles of food addiction.
Compare that to someone who dips a toe into recovery once a week – maybe at a therapy session, group or 12-step meeting. That's still a strong commitment and a wonderful act of self-care, but what happens in between?
If you've stopped gaining new insights from your journaling, if you're struggling to stay clean with your food, or if you're just feeling stuck in your recovery, it's time to take that next step. Here are just a few possibilities to consider: 
  1. Group work – Join a support group of people who are dealing with similar issues. If you're already in a group, try adding a second one.
  2. 90 in 90 – If you're in a 12-step program, try the "90 in 90" approach.
  3. Food log – Share your food log with someone every day as a way of staying accountable and honest with yourself.
  4. Shared meals – Find a safe and supportive place to prepare and eat healthy meals. Ask a friend or family member (you may even want to move in for a short time), or see if your treatment center or counselling center can dedicate a space for this purpose. 
  5. Inpatient care – There is something very powerful about surrendering your day-to-day responsibilities and putting yourself in the care of healing professionals.
  6. Intensive therapy – If you're doing one therapy session per week, consider upping that to two or three sessions.
  7. Support team – Add people to your support team. This will probably be a mix of professionals, friends and family. Make more calls, schedule more visits and ask for the support you need.
  8. Community service – Volunteering to help others is a way to focus on something other than your food issues.
  9. Creative expression – Write stories, poems or your own life story. Make music or art. These pursuits can be very therapeutic and personally fulfilling.
  10. Sharing your story – At the White Picket Fence Counseling Center, we host events called "Living Room Stories." Sharing your experience can be healing and validating for you as well as very important for those who need to hear about your successes.
If things are going well in your recovery, you may be thinking you don't have to worry about any of this. Why rock the boat? It can be painful to keep pushing through every new issue that is revealed. It can leave you feeling raw and vulnerable.

Keep going up those steps. It's worth it. The amount of effort you put into your recovery will determine the level of relief you get from your eating disorder and food addiction. And don't forget – there are people who can help you walk through this tough stuff. 


Seeing The Truth

In previous articles, we've been looking at the issue of denial. Denial is one of several defense mechanisms we all find ourselves using, even if we're not aware of it. When we use a defense mechanism, we are trying to protect ourselves from unpleasant emotions and feelings.
Although on the surface this sounds like a good thing, this tactic works against us by keeping us from seeing things as they truly are, effectively addressing our problems and issues, and moving forward with our lives in a positive way.
Some of the most frequently used defense mechanisms in individuals with eating disorders are rationalization, projection and denial.
When we use rationalization in relation to food, we use a plausible excuse to justify our behavior. ("Although I planned it, I didn’t eat that snack because I knew I was going to eat again in three hours!")
Projection is when we assign our own thoughts, feelings or motives to another person, e.g., accusing a co-worker of being angry at you rather than recognizing your own anger.
Denial, the most common defense mechanism, is when we completely reject that we have a thought or feeling, or that we are engaging in a specific behavior. ("It wasn't me who ate all the ____________”! or “I am training for the triathlon only because I can have structured workouts with a group and not be exercising alone in my house”.)
Reducing the use of defense mechanisms helps us to engage in the process of personal growth. As we rely less on defense mechanisms, we become more in touch with ourselves. We begin to increase our awareness of our thoughts and feelings and develop a healthy acceptance of those thoughts and feelings. We become less critical and judgmental of ourselves, and learn to develop a repertoire of coping strategies that, in the long run, serve us much better than our defense mechanisms. Aside from connecting better with ourselves, we also connect more with others, and that's a very good thing! 


Who does your addiction hurt?

This month we're looking at denial, a big issue for people with all types of addictions, including food addiction and eating disorders.
Denial in relationships

Addicts often think their behavior is invisible to others. It's like how little kids play peek-a-boo. They think that as soon as they cover their eyes, we can't see them, either. Dogs will do the same thing – as soon as they turn away from you, they'll try and get away with stuff they shouldn't be doing because they think they've turned invisible.
There's an expression that food addicts and those with eating disorders "wear" their disease. Whether it's excess weight, dull eyes and complexion, swollen glands or a sad expression, there's not much about the effects of an eating disorder that are hidden – especially to the people closest to them.
Food addicts and emotional eaters may also be in denial about how their addiction impacts the other people in their lives. These disorders affect everyone in the family. And that's a sad fact to face.
Breaking through the denial
Overcoming denial is one of the first steps of recovery – sometimes people address it before they even make the call to come and see us. Yet breaking through denial is like peeling an onion.
For someone who's always been a "good girl," it can be shocking to realize that you're lying about what you're eating, how much you're eating, or what you're doing with food and exercise. Or maybe it's something else – like shopping, over-spending, or people-pleasing.
While only the person with the problem can face the denial and make that breakthrough, there are some strategies that we use in therapy to help make that happen.
Motivational interviewing is a form of questioning that confronts the way someone is thinking, and provides evidence for a new way of thinking. For example, addicts can easily get caught up in "all or nothing" thinking. In that case, the therapist can point out options in the middle area, which the person may not even have considered.
Groups are an excellent way to pierce the denial, because you'll hear other people say they have a problem. If you can relate to what they've shared, it may open your mind to acknowledging that you have the problem as well. You'll also be able to support other people and witness as they get through their denial as well.
Is there something you've been denying to yourself or others? Is it time to break through?


Are you lying to yourself?


Denial leads to relapse
Have you ever heard the expression, "Denial is not a river in Egypt"? It's also the name of a funny book of sayings for people in recovery, and denial is the theme of this month's blog posts.
Alcoholics will often minimize their consumption and say they're drinking less than they actually are. Meanwhile, because of the changes that happen in brain chemistry in addicts, the more they drink the more they need to drink in order to feel normal, let alone good.
The exact same thing happens in people with food and weight obsession. Whether it's how long they exercise or how much they eat (either restricting or overeating), they need more and more of the behavior – but will still under-report what they're actually doing. Tolerance continues to grow, and so does denial, until soon they're in full-blown food addiction. Usually, it's someone else who recognizes it before the person with the food addiction – a friend or counselor may be the one to point it out.
Complacency is a form of denial
People get excited and enthusiastic at the beginning of the recovery process. They're in therapy, a support group or a 12-step program, and they're taking actions. Inevitably, something happens in life, or they just wake up a little tired one day, or that "high" of early recovery wears off and they become complacent.
Complacency becomes a form of denial. In addiction recovery, we talk about something called euphoric recall – people dwell on remembering the "good old days" of indulging in their addiction, and completely deny that there were any harmful, unpleasant or life-threatening effects.
Being in recovery can seem boring compared to a fantasy of life with excess food. That's why in 12-step recovery, the first step is often to write out a history of all of the ways that food, weight obsession, over-exercising, etc. made your life unmanageable. Please contact us at White Picket Fence Counseling Center if you would like to try a journaling exercise like that.
Denial is a definite path to slips and relapse. Let's say someone has long-term abstinence from binge eating. She has a slip, one binge, but gets right back in the saddle. She may decide, "Hey, I can handle a binge once in awhile," and it happens again, and again, until all of a sudden (but it's really not) she's face down in the food again.

In the next post, we'll look at how denial can affect relationships, and some of the ways we address denial in the therapy process.



The Return from Relapse

Feature Article - February 2011 

This can be a difficult time of year for food addicts, compulsive eaters and those with eating disorders. There is still all of that pressure that follows a holiday season, all the after-effects. And then comes the talk about resolutions and weight goals; food and weight seems to be on everyone's minds and it's a big topic of conversation. Then comes slips, relapses and consuming thoughts about what to do next...
We see a lot of “slips” at this time of year, and sometimes those slips turn into full-blown relapse. It's never easy to come back from a relapse. You may feel embarrassed and ashamed, especially if you've had a period of long-term recovery. You may worry that the people around you won't understand - and for good reason, because they maybe won't.
That's why relapse is such an important time to reach out for professional support. This is not the time to try to go it alone or punish yourself by isolating or continuing to suffer. That will just fan the fire and "feed" the relapse. Now is the time for self-compassion, and allowing someone else to help you.
If you're returning from relapse, try these suggested steps:
  1. Seek the professional help of a therapist. The validation you will get there is such an important first step. The other people in your support system may not fully understand what you're going through, and their confusion can just make things harder for you.
  2. Get checked out by your medical team, including your family doctor. Make sure that you're safe and ready to heal on a physical level.
  3. Be gentle with yourself but fight the eating disorder with everything you've got. Don't give up.
  4. Consider signing a relapse contract with yourself. Some people commit things like: I will be compassionate with myself, or I will not harm myself.
  5. Look at what led to the relapse. What part was your responsibility? What was slipping prior to the actual relapse? Some people take an inventory of these slips as a form of self-assessment and reflection. From there, consider if there is something in your environment that needs to change, in order to prevent this from happening again.
Above all, remember that every slip and every relapse is an opportunity to learn and grow. It's the truth. Accepting that truth will allow you to find the positive gem in this challenging situation.


When We Slip and Fall

Tara Harvill
Tara Harvill, MA
Registered Marriage and
Family Therapist Intern
and Registered Mental
Health Counselor Intern
A Note from Tara 
Relapse – the etymology of the word is “who falls again.” This brings a smile to my face, as I recall a recent spill I took hurrying to a meeting. Picture this: it was a full-on, totally uncoordinated, arms and legs flailing, books-purse-folders flying, as seen on America’s Funniest Videos kind of incident.
Of course, I was not smiling at the time. In that moment, I felt embarrassed, frustrated, sad, disappointed, and physically injured (I had twisted my ankle and developed a huge bruise and knot on an already previously injured knee – yes, from another recent fall), not to mention the huge blow to my ego. As I felt my eyes well up with tears, the first place my mind went was to go home, call in sick, and wallow in my pitiful experience.
Okay, I know in the grand scheme of things, this doesn’t sound like a big deal. That’s exactly why I’m smiling now! The point is that I didn’t go home, etc. I took a deep breath, brushed my pants off (thank goodness I wasn’t wearing a dress), gathered up my belongings, and proceeded to my meeting. At the end of the day, I felt glad that I didn’t alter the course of my day as a result of that one event.
This may sound like a very trivial metaphor for relapse, but the essence of the story can be overlaid onto some of my most difficult challenges in life. After the fact, many of my struggles, disappointments, and "relapses" (times that I have returned to previous patterns of behavior, which is the definition of relapse) morph into strengths, accomplishments and life lessons. And, yes, I’m quite sure I will fall again. With each fall, though, I feel more certain I will be able to get back up!