Practicalities - anzaed.org.au

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Beyond Body Image: The Body as a Resource in ED Recovery

Presenters:Janet Lowndes; MAPS, RYT

Director; Mind Body Well

Fiona Sutherland, APD, RYT

Director; The Mindful Dietitian

Practicalities

• Please use Q&A box for anything you'd like Fiona and Janet to see. We will not be viewing the CHAT box

• Due to the large number of participants, your microphones will be muted during the presentation and question periods, all questions will be via the Q&A

• You’re welcome to have your video on or off, the choice is yours

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Introduction and Foundations

Our focus today

1. Introduction

2. Body Image

3. Intrapersonal - Embodiment

4. Interpersonal - Collective

5. Practice and Growth

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Our invitation to you…

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Reflective qns

• Do you live in a body that experiences pleasure, pain, agitation, excitement, sadness…

• Do you work with other who experience pleasure, pain, agitation, excitement, sadness…

Assumptions we are bringing:

All humans have an intrinsic need to feel safe

We develop coping strategies in an attempt to feel safe in our bodies (for

some people, this is experienced as ED symptomatology)

The way forward is not just about reducing

symptomatology, but involves returning to our

bodies in adaptive, healthy ways

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“To effectively prevent and treat eating

disorders those at risk and struggling must

learn how to navigate life without leaving

themselves or turning against their bodies”

Cook-Cottone, 2016, p.105

The work we do within ourselves (within us, clients within themselves)

The work we do which intersects with our clients work

The work which resides in our culture.Common humanity, shared experiences

Intra-personal

CollectiveInter-

personal

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Body Image

History and definition of BI

“The image of the human body means the picture of our own body which we form in our mind, that is to say, the way it appears to ourselves” (Schilder, 1935)

“internal representation of your own outer appearance” (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999

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How is the body conceptualized (if at all) in our current evidence based approaches for EDs?

Building on best practice in EDs

EDs are inextricably entwined within the context of culture and how the body and the notion of embodiment are held

within culture, as are approaches to ED treatment

(Gordon, 2017)

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Why move from traditional “treatments” to embodied approaches?

▪ Treatments for ED have improved with a growing empirical base indicating, at best, moderate efficacy (Linardon & Wade, 2018; Zeek et al., 2018)

▪ Findings reinforce the contention that interventions have yet to address the full scope of variables driving ED behaviour (Dilberto& Hirsch, 2019)

▪ Treatment recommendations appear to support decreasing ED symptomatology and key mechanisms underlying core symptoms with only moderate success, at best.

From managing symptoms to embodying a positive relation to

oneself.

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Positive Embodiment

3

Mechanisms, underlying symptoms 2

ED Symptoms1

3

2

1

Positive Embodiment

3

Mechanisms, underlying symptoms 2

ED Symptoms1

3

2

1

Abnormal, disordered

Targets for reduction

or eradication via

cognitive &

behavioural tools

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Positive Embodiment

3

Mechanisms, underlying symptoms 2

ED Symptoms1

3

2

1

Body as valuable

resource, safety seeking

Use cognitive &

behavioural tools

PLUS

opportunities to practice

skills & develop increased

capacity for positive

embodiment

The Embodied Self (Cook-Cottone)

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Intrapersonal -Embodiment

Embodiment

“The lived experience of engagement of the body in the world”. (Philosopher Merleau-Ponty, 1962)

“Mind and body are inseparable, and the body

is not only the centre of perception, but also of

subjectivity: experiencing the world

meaningfully”. (Piran (2017), p.2).

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Embodiment

“A way of being (non-dualistic conceptualisation self) in which being is

understood as residing in and manifesting from the body as one

experiences the:

- internal (ie. physiological, emotional, cognitive)

- external (ie. interpersonal, social, cultural), and

- existential dimensions of life”.

Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.1

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Dimensions of the Experience of Embodiment

NEGATIVE POSITIVE

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REFLECTION

INTERRUPT ENHANCE

What experiences might interrupt V'S enhance, healthy embodiment?

Positive Embodiment - EXAMPLES

INTERRUPT ENHANCE

Trauma / abuseShameDietingMisassigned gender at birth / MisgenderingIllness / injury / pain / disability / medicationsEarly needs not adequately metDisruption to early feeding Learned mistrustStigma / oppression / marginalizationRacismFood insecurityUnhelpful role modellingLearned body dissatisfactionFertility issues and treatmentsStigmatising medical careetc...

Secure attachmentEarly ‘successful’ feeding Early needs adequately metRegular embodied practicesHelpful, positive role modelling Support to navigate natural body-related experiences eg.Puberty, pregnancyOpportunities to enjoy the body / be playfulCulture and community of acceptance – diversityGender identity acknowledged and honouredMedical care accessible and stigma-freeBeing safe to resist objectificationetc...

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Moving from body as OBJECTto body as RESOURCE

Requires:

1. Listening, experiencing and knowing

2. Trusting and responding

3. Inhabiting and celebrating

1. Listening, experiencing and knowing

INTEROCEPTION - “The process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels”.

Khalsa et.al. (2017) ‘Interoception and Mental Health: An Overview’. Biological Psychiatry

NEUROCEPTION - “Neuroception represents a neural process that enables humans and other mammals to engage in social behaviors by distinguishing safe from dangerous contexts. Neuroception is proposed as a plausible mechanism mediating both the expression and the disruption of positive social behavior, emotion regulation, and visceral homeostasis.”

Porges (2008) ‘The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system’.

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2. Trusting and responding

What’s required in order to trust and respond to my body?

WILLINGNESS - am I prepared to give my body what it needs?

RESOURCES - do I have access to the necessary resources to adequately respond to my body?

COURAGE / SAFETY - Is it safe for me to give my body what it needs?

SUPPORT / COMMUNITY - am I well supported to take these steps?

3. Inhabiting and celebrating

What does it mean for you, and for people you know to inhabit and celebrate their bodies?

• Safety

• Connection

• Freedom

• Liberation

Explore the personal meaning of this

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Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.31

Practice Tip

Actively bring the body into the therapeutic conversation.

Listen out for any experiences your clients share which reflect connection and/or disconnection from their bodies?

• Slow down

• Connect - self and other

• Affirm

• Validate

• Stay with

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Interpersonal & Collective

Intra-personal

CollectiveInter-

personalWhat supports people

to feel safer in their bodies in their work

with us?

What supports people to feel safer in their bodies in the world

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What does this image represent to you in terms of embodiment and the space we share with others?

The Inter-personal space

How do you think the therapists own embodiment impacts on the relational space between therapist and client?

What could the impact be of this relational space on a clients experience of and in their body?

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Therapeutic stance of embodied approaches

Doing toBeing with

What might happen when we feel “stuck” with someone’s body-related experiences?

1. Intellectualise – “fixing”

2. Rationalise – “this is normal for humans”

3. Avoid / distract / deflect – “let’s talk about something else” or “it’s not about your body”

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Our own experiences of embodiment

Positive Embodiment

INTERRUPT ENHANCE

Trauma, abuse, neglectDieting, inconsistent dietary intakeMisassigned gender at birthIllness / injury / pain / disabilityEarly emotional or physical needs not adequately metDisruption to early feeding relationshipLearned mistrustStigma / oppression / marginalizationRacismFood insecurityShameUnhelpful role modellingLearned body dissatisfactionMedications Fertility issues and treatmentsMisgenderingStigmatising medical care

Secure attachmentEarly ‘successful’ feeding Early needs adequately metRegular embodied practicesHelpful, positive role modelling Support to navigate natural body-related experiences eg.Puberty, pregnancyOpportunities to enjoy the body / be playfulCulture and community of acceptance – diversityGender identity acknowledged and honouredMedical care accessible and stigma-free

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Working with our own body AND the body of others

What the conditions we can provide to enhance safety and embodied experiences?

• Resonance (“I see you”)

• Expectancy (boundaries, integrity of practice)

• Co-regulation (ability to stay in safe and social, ventral vagal state)

• “Creating a welcoming environment” (Deb Dana, 2018) = “I feel safe here”

For more on this see the work of Porges, Dana, Fisher

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What are possible signals of safe/unsafe?

Consider – office space, language, recommending reading/podcast, website, interventions/treatment modalities

The collective work =

How can we ALL contribute towards communities and the world being a safer place for people in all bodies?

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Contributing to a more inclusive community

• Reflecting – with deep honesty – on our own beliefs about bodies

• Understanding how bias, stigma and discrimination show up in our research, community and treatment settings

• Being willing to partake in uncomfortable conversations and actively challenge myths about EDs which are based in bias eg. people in larger bodies with an ED must have BED

• Undertaking trainings in working with diverse groups and actively engaging in supervision

UnconsciousConscious

UnexaminedConscious Examined

ACTION

- Exposure to learning- Support / supervision

- Willingness - Exposure to learning- Support / supervision- Opportunity- Community- Courage - Tenacity

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Ways to expand our learning and advocacy

Exposure and engagement with those with lived experience• Fat positive• Disability• LGBTQI+• Age diversity

Advocating for more expansive and bold researchSpeaking up about stigma in research, interventions and treatment settings (even if it’s old but still well recognised)

Practice and Growth

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What sorts of practices may assist a client develop embodied awareness?

Please briefly type some of your ideas into the chat box…

Embodied Awareness and Self-Care

The language of self-care can be a valuable way to direct our clients toward embodied practices.

Self-care is already:

- recognised

- understood

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Mindful Self-Care Process

”The daily process of being aware of and attending to our basic physiological and emotional needs, including the shaping of our daily routine, relationships, and environment as needed to promote self-care”. Cook-Cottone (2020), p104

Requires:

1. mindful awareness of self-care as essential to wellbeing2. assessment of self-care domains3. assessment-driven self-care goal setting4. engagement in self-care behaviours

Cook-Cottone (2020), p.116

Mindful Self-Care Scale

1. Nutrition and hydration2. Exercise3. Rest4. Physical and medical care5. Self-soothing6. Self-compassion7. Relationships8. Environmental factors9. Spiritual practice10. Self-awareness and mindfulness

INTERNAL aspects of self

EXTERNAL experience of self

CENTRE of the self

Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.106

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What's YOUR personal Self-Care Plan?

1. Nutrition and hydration2. Exercise3. Rest4. Physical and medical care5. Self-soothing6. Self-compassion7. Relationships8. Environmental factors9. Spiritual practice10. Self-awareness and mindfulness

INTERNAL aspects of self

EXTERNAL experience of self

CENTRE of the self

Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.106

Thankyou!

[email protected]

[email protected]