How to Avoid Addiction Replacement after Bariatric Surgery.

Addiction Replacement (also referred to as Addiction Transfer) is when you quit one addiction and replace it with another.  Several recent studies have found that there is a substantial risk for developing alcohol use disorders after gastric bypass surgery.  The incidence is higher with gastric bypass than with other bariatric surgeries and is also higher in younger males than in other populations.  While most of the scientific studies have focused on alcohol use, anecdotal evidence (and common sense) suggest that other types of addictive behavior may also increase.  For instance, I was speaking at a conference recently and met a woman who after having bariatric surgery, then had back surgery where she was prescribed heavy-duty pain medication.  Not surprisingly, she became addicted to the pain pills.

If you think about it it makes sense.  Anyone who has reached the level of obesity that warrants bariatric surgery, has been using food beyond the need for physical sustenance and to serve another purpose.  They are food addicts.  Just like alcoholics or nicotine addicts use those substances to medicate their feelings, so too, food addicts abuse food in an attempt to "manage" their feelings.  But really, they are not managing their feelings, they are medicating them--trying to shove down the feelings or get rid of them temporarily. 

Bariatric surgery makes it more difficult (and dangerous) to overeat, but it doesn't take away your feelings and stressors.  So, if you don't find healthier ways of dealing with uncomfortable feelings, then you are more likely to try to repeat the same addictive behavior (either by overeating and risking serious injury, or turning to other addictions).  This is why many bariatric surgery facilities have intelligently started referring patients to therapists for psychotherapy before, during and after surgery.  So that, with the help of a therapist, patients can uncover and start to understand how they use food to deal with their feelings, and learn healthier ways of managing their feelings. The success rate and the safety of their patients (as well as the reputation of bariatric surgery) depends on patients finding healthier ways to tolerate feelings that don't involve addictive behaviors.  So really, this article should be entitled "Tolerating Feelings" since preventing Addiction Replacement requires learning to tolerate your full range of feelings, rather than trying to get rid of them or numb them out. 

What does that mean, to "tolerate feelings"?

You may have been taught that some feelings are "good" and others are "bad". Perhaps you have internalized messages from your parents or society that you are not "allowed" to feel certain feelings. "Boys don't cry," Girls who get angry are "B-tches". So we have to somehow manage those feelings without letting others know how we are feeling.

We all have feelings, pretty much 24/7, we have feelings of some kind. But certain feelings are more tolerable than others. For instance, "happy" is a feeling most people have little difficulty tolerating. In fact we'd often like more of that one. But other feelings we don't enjoy so much. Like for instance "stressed," "angry," sad," or "hurt"?
What happens when you have those uncomfortable feelings? You don't like that feeling, so you want to get rid of it, or make it stop.

We learn how to manage feelings, less by what our parents tell us, and more by watching how our parents and siblings handle their feelings. It may not be allowed to be "angry" but it may be accepted that people shove down their feelings until they "just explode." And that is the one rare exception when excuses are made for evacuating our feelings onto others. I just "lost it." But evacuating feelings can hurt us in our social and work lives. No one wants to be around a bully who's always evacuating his or her anger onto other people.

Maybe you've been taught that it's acceptable to "complain." "Misery loves company" as they say. But that also runs the risk of backfiring on you as you don't want to become "that" person who's always complaining or depressed or negative.

Another tactic people use is to shove the feelings down--with food, or alcohol, drugs, sex, etc. You may find that you do all of the above. When you stop using food to medicate your feelings, it's a pretty good bet that you'll start having a lot of those uncomfortable feelings coming up. You may find yourself getting angry with people (road rage is a great indicator that you are struggling with anger), or complaining a lot. Or as with addiction replacement, turn to other substances to try to shove down your feelings.

The problem with all of these is that in each case, we are trying to get rid of our feelings, by evacuating them onto other people through exploding, or complaining, or medicating them. But when you try to get rid of feelings, they don't stay "gone." They come back when another situation triggers them, or they rebound as other intolerable emotions, like shame, regret, self-doubt, and self-loathing. Which in turn need to be shoved down or gotten rid of, and the cycle comes around again.

Managing feelings in a healthy way requires Tolerating Feelings and not trying to get rid of them. So "how do I do that?" Here's how...

*Note, everything I know about tolerating feelings, I learned from my own analytic work with Dr. Diane Renk.   So she deserves even higher billing than a co-author on the following condensation of that work.*

Healthy Ways to Tolerate Feelings without Addictive Behavior

Managing feelings without self-medicating requires being able to tolerate uncomfortable feelings that may seem completely intolerable. Here are a few ways that you can tolerate feelings and deal with them in a healthy way.  

1. Use the Mental Muscle. All of the steps below are part of using your mental muscle, and they also require that you first use the mental muscle to slow down and allow yourself the time to work through these steps rather than just diving into and getting carried away with whatever intolerable feeling you are feeling. Like any muscle, the mental muscle will feel weak at first but get stronger the more you use it.

2. First you need to identify what you are feeling. If you've spent most of your life using food or other substances to medicate your feelings away, it may be hard at first to identify your feelings. Some people go straight to anger when they're really feeling sad or disappointed. And others go straight to sad when they're really feeling angry. Take a pause to figure out what are you feeling? Sad? Angry? Hurt?

3. Accept that this is how you are feeling right now, and just allow it to be present in your inner world without trying to shove it away, deny it, evacuate it, or act on it in any way. Just let it be there. Remember, all feelings are temporary. This too shall pass.

4. Don't hurt yourself. Remember, diving into a bottle or a pint of ice cream is not taking care of yourself, it is hurting yourself. So why would you hurt yourself when you're already having such a hard time?

5. Pay close attention to your Self-Care when you are dealing with uncomfortable feelings. Think of it as taking good care of the you that's having a really hard time right now. Take care of yourself as if you were feeling your best! Just a few self-care items might be:

• Keep tracking your food
• Don't veer from your meal plan at all
• Get up on time--don't oversleep or stay up too late
• Keep exercising
• Keep up healthy cleaning rituals--ie don't let the dishes stack up...so you can feel good living in a clean place.
• Keep up your hygiene--take showers, wash your hair.

6. Don't make things worse. Evacuating your feelings on someone else will likely do more damage to your life than just sitting with the feelings and letting them be your own. Similarly, taking substances or shutting down will also cause you to lose time, may damage your relationships at work and home, and damages your self esteem and confidence in your own ability to deal with life. If you're having intense feelings, it's best not to do anything at all.

7. Talk to a therapist or other trained professional. Therapy can give you someone safe with whom to discuss your feelings. This person is objective, and can help you identify your feelings and why they are so intense, and also help you manage them. Sharing with a friend or family member may leave you feeling empty and alone because the other person doesn't know how to help or has their own agenda. Also, depending on how you share your feelings, you run a higher risk of damaging relationships if you evacuate on your friend or spouse, or lash out and say hurtful things. A therapist is trained to deal with the full range of emotions and can help you work through things in a safe environment.

8. Get some Peace by taking care of your spiritual needs. This is different for everyone. But it helps to have some sort of spiritual life, whether that is religion, your personal relationship with your idea of a higher power, meditation, yoga, etc. Sometimes praying for peace of mind or just calming yourself by sitting quietly in meditation can allow you to quiet down the noise in your mind and allow you to get some peace with the feelings that you are feeling.




Bibliography:

King WC, Chen J, Mitchell JE, et al. "Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery." JAMA.2012;307(23):2516-2525. doi:10.1001/jama.2012.6147. CONCLUSION: the prevalence of AUD was greater in the second postoperative year than the year prior to surgery or in the first postoperative year and was associated with male sex and younger age, numerous preoperative variables (smoking, regular alcohol consumption, AUD, recreational drug use, and lower interpersonal support) and undergoing a Roux-en-Y gastric bypass procedure.

Svensson PA1, Anveden Å, Romeo S, Peltonen M, Ahlin S, Burza MA, Carlsson B, Jacobson P, Lindroos AK, Lönroth H, Maglio C, Näslund I, Sjöholm K, Wedel H, Söderpalm B, Sjöström L, Carlsson LM, " Alcohol consumption and alcohol problems after bariatric surgery in the Swedish obese subjects study." Obesity (Silver Spring). 2013 Dec;21(12):2444-51. doi: 10.1002/oby.20397. Epub 2013 May 31... http://www.ncbi.nlm.nih.gov/pubmed/23520203. CONCLUSION: Alcohol consumption, alcohol problems, and alcohol abuse are increased after gastric bypass and VBG.

Ostlund MP1, Backman O, Marsk R, Stockeld D, Lagergren J, Rasmussen F, Näslund E. Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive bariatric surgery. JAMA Surg. 2013 Apr;148(4):374-7. doi: 10.1001/jamasurg.2013.700. CONCLUSIONS AND RELEVANCE: Patients who had undergone GBS had more than double the risk of inpatient care for alcohol abuse postoperatively compared with patients undergoing a restrictive procedure, highlighting a need for healthcare professionals to be aware of this for early detection and treatment.

Mitchell JE1, Steffen K2, Engel S2, King WC3, Chen JY3, Winters K4, Sogg S5, Sondag C2, Kalarchian M6, Elder K7. Addictive disorders after Roux-en-Y gastric bypass.Surg Obes Relat Dis. 2014 Nov 13. pii: S1550-7289(14)00432-8. doi: 10.1016/j.soard.2014.10.026. [Epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/25862182 CONCLUSION: These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.

Coker Ross, Carolyn, MD, MPH, "Weight-loss Surgery and Cross Addiction: A Look at Binge Eating Disorder." http://www.obesityaction.org/educational-resources/resource-articles-2/weight-loss-surgery/weight-loss-surgery-and-cross-addiction-a-look-at-binge-eating-disorder

Poladian, Charles, "Gastric Bypass and Addiction Transfer - One Woman's Story." Medical Daily, Jun 11, 2012 03:07 PM.  http://www.medicaldaily.com/gastric-bypass-and-addiction-transfer-one-womans-story-240778

BT Online Editor, "Transfer of Addiction and Considerations for Preventive Measures in Bariatric Surgery."  Bariatric Times.  April 26, 2007.  http://bariatrictimes.com/transfer-of-addiction-and-considerations-for-preventive-measures-in-bariatric-surgery-part-ii/

Yin, Steph, "Alcoholism after gastric bypass: Is it in your mind or gut?"  From ScienceLine.org.  January 9, 2015.  http://scienceline.org/2015/01/alcoholism-after-gastric-bypass-is-it-in-your-mind-or-gut/

The Mental Muscle Company.  http://www.thementalmusclecompany.com/

Dr. Noel Blundell's Mental Muscle.  http://www.mentalmuscle.com/

Alex Hutchinson, "How to Build Mental Muscle."  Runners World, September 16, 2013.  http://www.runnersworld.com/race-training/how-to-build-mental-muscle

SanitySoap.com, "Learning to Tolerate Difficult Feelings," by Crystal.   http://sanitysoap.com/post/95964165914/learning-to-tolerate-difficult-feelings

 

WHAT IS MINDFUL EATING?

The term "mindfulness" is widely used in a variety of fields today--we hear about "mindful parenting," "the mindful manager," "mindful meditation," and in the diet and eating disorders field, "mindful eating."  But what does "mindful Eating" really mean?  It can help to turn the term on its head.  Do you know what "mindless eating" is?  Most people, especially those reading this blog, have an expert knowledge of "mindless eating."  So, yes, in its most common-sense definition, mindful eating is the opposite of mindless eating.  And that gives us a good place to start.  Now for a more detailed explanation... The concept of "mindfulness" comes from Buddhist philosophy, and generally means "awareness."  In Buddhist philosophy, "mindfulness" is one of the seven factors of enlightenment.  The goal of mindfulness is to overcome greed, hatred and delusion.  What's a delusion? A delusion is a belief that we hold on to, even though it is not based in reality.  We may even know, on some level, that it is not based in reality, but choose to believe it anyway.  There are many types of delusions.  Can anyone think of an example?  How about food-related delusions? 

                "I can have my cake and eat it too." 

                "I just walked 5 miles, so I can eat dessert tonight."

                "If I don't write it in my journal, it didn't count."

Buddhism tells us that Mindfulness, or having an "attentive awareness of the reality of things" (especially the present moment), is an antidote to delusion.  So, when you are being "mindful" you are slowing down and paying attention to the reality of things in the present moment, and if you do that, then you can't sustain a delusion. Mindfulness becomes a power when it is coupled with clear comprehension of whatever is taking place.  "Clear Comprehension" means basically a  good understanding of what's going on with you, in your life, in that moment.  So, in order to have a "clear comprehension", you may need to really look at yourself, how you grew up, how you developed your relationship with food, how much power you project onto certain foods, and re-examine some of your ideas and assumptions about food and eating.  In psychoanalysis this is referred to as making the unconscious conscious, and that is one of the main goals of therapy.  You need to have both, "mindfulness" and "clear comprehension" in order to have power over your life, and specifically what we're working on today, having power over your eating. 

So how do you become mindful about your eating?  First of all, you need to slow down the process, and tune in to your physical and emotional state in the present moment, giving yourself time to breathe and get in touch with how you are feeling in that moment that you feel hungry. 

We live in a culture that values fast-paced, multi-tasking lifestyles.  And so it's not surprising that we tend to eat in a rush, oftentimes not even tasting or experiencing the food that we are eating.  It makes sense that we don't feel satisfied because we don't take the time to fully enjoy and experience the food we're eating, or give our bodies a chance to feel full.  Most people who struggle with a food addiction, are very familiar with "mindless eating?"  Sitting in the car scarfing down a burger and fries, sitting in a movie theater powering through a huge tub of popcorn?  If you are a binge-eater, you know exactly what I'm talking about.  It's like you are in a trance when you are on a binge.  You are completely disconnected from your physical and emotional experience in the moment.  Do you understand what I'm talking about when I talk about your "physical and emotional experience in the moment."  When you have a food addiction, chances are that you use food to fill up not only your physical hunger, but also your emotional hunger.  Do you know the difference between physical and emotional hunger?  When you've struggled with overeating or bingeing, it can become very difficult to tell the difference.  Can anyone give me an example of when they ate because they were emotionally hungry, but not really physically hungry?  What's happening in that moment?  You're over-riding your physical hunger cues because somewhere in your inner world, you've convinced yourself that food helps you feel better emotionally.  But that is one of those delusions we talked about.  Because it doesn't really make you feel better.  It may distract you momentarily, but then (usually very quickly), your unpleasant emotions come back in full force and are joined by new ones of remorse, guilt, shame, anger, helplessness, etc.  And the internal bully takes over and starts making you feel bad again, which in turn, makes you want to eat. 

After years of eating mindlessly, it's no wonder many people feel like they can never again get reconnected with their own experience of hunger, how hungry they really are, how much food they really need to eat.  In fact, after years of mindless eating, we begin to believe that we can't possibly know how much we need to eat.  We look to the food labels to tell us how much a serving is, because we've become so disconnected from the experience of eating for nourishment that we can't remember, or maybe never knew what was a "normal" or "healthy" serving.  One person told me that they bought a bag of goldfish crackers and to try to control their intake (rather than eating the whole bag), looked at the bag to see what a serving size was, and separated the bag into little baggies of one serving each.  A serving was 35 goldfish.  But one day, while driving she powered through a whole bag of 35 goldfish crackers and realized at the end that she hadn't even really tasted them.  She had been shoving them in her mouth one after the next without even taking a breath in between.  That's why when health professionals talk about "intuitive eating" many food addicts just laugh at the idea, knowing that if they trusted their "intuition" to tell them how much to eat, they'd never lose weight. 

So, practicing mindful eating a little bit each day, even for just a few minutes, can quickly help you get back in touch with your body's cues, how much you need to feel full, and identify what is physical or emotional hunger, so that you can gain back power over your eating.     Another very helpful tool in discerning physical hunger from emotional hunger is your food journal.  If you've already eaten most of your allotment of calories today, chances are pretty good it's emotional hunger. 

Just as with any new concept, understanding is one thing, and doing is entirely another.  Take a few moments to walk through the experiential exercise below.  This is best done with some sort of small finger food like grapes or edamame.  Make sure you have your choice of finger food in front of you, along with a plate or napkin.  Make sure it is a quiet place where you can be alone and focus for a few minutes.

MINDFUL EATING EXPERIENTIAL EXERCISE

Close your eyes, and pay attention to your breathing.  Breathe in and out slowly.  Notice how you are breathing.  Is it deep or shallow, are you barely breathing?  If so, try to slow it down and breathe a little more deeply.  As you are breathing in, count one, ... two, ... three... now exhaling, count one,... two... three. 

Notice how your body is feeling... Is there tension in your body?  If so, imagine breathing into the tense places and sending your breath there, and then on the exhale, one... two... three... release the tension with your breath. 

You might notice distracting thoughts coming into your head as you are doing this.  Try not to hold onto the thoughts, let them flow into your mind and then out of your mind on the exhale.  Notice how you are feeling emotionally.  You may notice some anxiety, as this is new and strange, or you may feel calm and relaxed.  Whatever you are feeling, allow it to flow over you without judgment, and then on the exhale release the feelings. 

Now, try to notice your hunger level.  Are you feeling hungry?  Is it a physical hunger, or an emotional hunger?   Try to tune in to the physical hunger, and let the emotional hunger flow over you and as you are exhaling, let the emotional hunger flow away.  Gently bring your mind back to the physical hunger.  Is it absent? Are you full?  Or if it is there, is it small, medium or large hunger?  Does it seem overwhelming?  If so, try to breathe some of the overwhelming feelings out on the exhale... one... two... three...  What does your body need right now? 

Now slowly open your eyes. 

The next part of mindful eating is staying centered in the here and now, as you are eating.  Take some grapes or edamame and put them on a plate or napkin in front of you.  Take as many as you feel hungry for--take a small amount for a small hunger, a medium amount for a medium hunger, and large amount for a large hunger.  Don't worry about how many counts as small, medium or large for you.  Everyone is different. 

Pick up one grape or one edamame.  If you have both, pick up the one you feel you are the most hungry for.  Take some time to look at it.  Turn it around in your hand.  Feel the surface  and the texture.  What do you notice about it?  How does it smell?  You can share things you notice with the group if you'd like...

Now put the grape or edamame into your mouth.  Don't bite down, just let it sit on your tongue.  Notice the taste.   Can you still smell it?  How does it feel in your mouth?  How does the skin taste or feel on your tongue?  Is it spicy?  sweet?  earthy?  You can turn it around in your mouth a few times so that can feel all sides. 

Now bite into it.  How does it taste?  Notice the juice or the meat and if it tastes differently...  Is it sweet?  spicy?  Is there a little zing?  How does it feel on your tongue?  Slowly chew it and try to notice as much about it as possible.  The taste, the smell, the feel?  The way your mouth reacts to it? As you swallow, notice the way it feels going down.  How does your throat and stomach react to it.  Can you feel it in your stomach? 

Did you notice anything that surprised you?  What was this experience like?  What did it bring up for you?  Did it make you feel impatient? bored? content? 

Now focus back on your hunger.  Is it still the same size?  Is it a small hunger, a medium hunger, or a large hunger?  How has it changed?  How much do you want to eat another one?  Are you hungry for something different now?  Did anyone find that they went from a large hunger to a small hunger?  Or was it just one step down?  Or did it not change at all?  Were you surprised at how quickly you felt satisfied or how one little piece of food could be so satisfying? 

How does this compare to how you normally feel when you eat?  Is anything different?    How often is it that, during a meal, you ever put your fork down?  Many of us just power through our meals and don't put the fork down until we are done.  So if you make a point of putting your fork down from time to time, it gives you a chance to enjoy what you've just eaten, and to tune into your body and really experience the enjoyment of eating and a good meal.  It also will give your body some time to feel full. 

How can you see this working or not working in your daily life?  Obviously when you are out to dinner with friends, or eating in a group, or on the run, it can be difficult to go through this whole process of slowing down and getting in touch with your breathing, and your body, closing your eyes, examining the food, smelling it, placing it in your mouth and not biting down or chewing right away.  So, how can you do this in daily life?  There are a couple of simple techniques to make even your most crazy day a mindful eating day.  See the Tips for Mindful Eating article below.

Copyright © 2014 Sue Brekka, M.A., MFT

MINDFUL EATING TIPS FOR DAILY LIFE

1. As soon as you feel hungry, take three slow and deep breaths.  
2. Ask yourself, is it Physical Hunger or Emotional Hunger?  a little of both?
3. Tune in to your body.  How hungry are you?  Is this a Small, Medium or Large hunger?
4. Think about how much your body needs to be nourished and what kind of food it needs.
5. Use your knowledge of yourself, nutrition, and health, to choose something to eat that will be nourishing and fulfilling.
6. Notice how the food smells.  Are there different smells?  Is it sweet, spicy, tangy?
7. Take a moment to look at it and notice how it looks.  If it is finger food, like a grape, go ahead and pick it up and look at it. Feel the texture. 
8. When you put it in your mouth, take a beat before chewing, and allow yourself to taste and feel it in your mouth.
9. Chew slowly and try to notice the texture, feel, taste, smell of what you are eating.  Really enjoy each bite to the fullest before you swallow. 
10. Take some time to notice how you feel as you swallow and the food goes down into your stomach. 
11. Give yourself a few moments to notice how your body feels now.  How hungry are you now?  Give yourself a chance to feel hungry before you take the next bite.
12. Each time you take another bite, make it small and go through the process again, slowly.
13. PUT YOUR FORK DOWN. This is not a race.  From time to time, give yourself a break by putting your fork down so that your body has time, to feel full. 

 © 2014 Sue Brekka, M.A., MFT        11040 Santa Monica Blvd., Suite 208, Los Angeles, CA 90025           www.suebrekkamft.net

Life is a marathon, not a sprint

If you’ve ever trained for and completed a marathon, you understand how much dedication, consistency and patience it takes to accomplish that goal.  Getting up in the wee hours of the morning on Saturday to go meet the running group, slogging through mile after mile, increasing the mileage week after week, and cherishing the few “rest” weeks where you get to do 10 miles instead of 18—What a relief!  During the week, no matter how busy you are, you find time either by getting up earlier than usual to get in your miles before work, or going out to the gym or outside in the dark to run at night.  Regardless of how tired you are, you do the mileage that the training program/book/website  says you’re supposed to do—or at least a close approximation thereof.  You know you need to either do the mileage that day, or you’ll have to make it up later, so may as well go ahead and do it.   You may even become obsessive about how much you sleep, whether or not you carbo-load, what gels or gu’s you take with you on a run, how much Gatorade or water you drink…  All because you know you need to have put in the miles and prepared your body to be out there for 26.2 miles.  You’ve tried out different things that either worked or didn’t work so that you don’t get to race day and try a new gel that makes you hurl. 

Then on race day, you hit a wall, or several walls along the way.  Each time you’re faced with continuing on or quitting.  At mile 8, say you start to feel like you’re wiping out.  But it’s only mile 8, you can’t quit now, so you take a gu or gel or Gatorade to keep you going.  And you keep putting one foot in front of the other.  Then again, at mile 20, coming up a big hill, you hit another wall!  This time you seriously consider quitting.  But you can’t quit—you have to finish.  It’s only 6 more miles.  So you keep going.  At mile 22, you think, “I don’t think I can pick up my feet anymore.”  And then you think, “well if you think that way, then you won’t be able to—so stop psyching yourself out! And just try!”  So you keep picking up your feet.  Even if every step hurts, and it seems like you’ll never get to the finish line, you keep picking up your feet.  Just keep putting one foot in front of the other.  You have to hold onto that hope that eventually you get there.  And then, … you do!  And it’s done!  You’ve just run a marathon!  You’ve got a new medal around your neck, probably an aluminum blanket thrown around your shoulders and you don’t think you can walk another step to get to your ride home.  But of course, you do.. what choice do you have. 

This is what life is like.  There’s very little instant gratification.  And sometimes, there are very few things that you can control in life.  And just when you think things are great, something bad happens.  That’s the way life is.  But do you give up?  No.  You keep putting one foot in front of the other.  For all of the people who’s industries have disappeared or morphed into something new, and they’re having to recreate their careers and find new sources of income, it may feel like things will never get better.  For the husband and wife who are going through a divorce, it may feel like things will never be stable again, or they’ll never find love again.  For the kids whose parents just got divorced and they’re shuttling back and forth between two homes, it may feel like they will never have a “real” home.  There are births, there are deaths, there are lost jobs and gained jobs.  There are marriages and divorces.  There are wars and at times there is peace.  But most of that you have no control over.  You can set up a few things that you know will make your life easier—like managing your eating and sleeping, doing the work you have or using your time productively towards whatever goal you’re reaching for.  But the gratification may not come right away.  It may not come for some time.  And you have to tolerate the frustration of waiting for something good to happen, or something to finally “work out.”  And until it does, you have to keep putting one foot in front of the other—even if every step hurts.  Keep picking your feet up, even when you don’t think you can.  Keep the things that you can control under control—stay focused on the goal.  And no matter how frustrated or hopeless you feel, just keep plodding along.  Eventually, maybe not today, maybe not tomorrow, but eventually, you will get where you want to go. 

Changing Unhelpful Scripts in a Financial Crisis

We all have them, our own inner scripts, that play through our heads over and over again.  We may be aware of them, or they may run quietly under the surface as expectations or assumptions we have of ourselves.  For instance, some positive scripts are, “I can succeed at anything I put my mind to,”  “I make friends easily,” etc….  These scripts can be very helpful in keeping us going through difficult times. But we also have negative inner scripts--the ones that are unhelpful or stop us from succeeding in our lives.  For instance, the one that says “No matter how hard I work, or how much I scrimp and try not to spend, I can never get out of a paycheck-to-paycheck type of life.”  Or, “I’ve tried every diet and failed, so why bother, I’ll never lose this extra weight.”  If you’ve ever kept a journal, and you look back at old entries, you may have noticed that these negative scripts appear over and over again, year after year.  Even if you are in four-times a week psychoanalysis, these scripts continue to reappear.  That’s because they are ideas that we’ve internalized into our basic self-concept.  They most likely were messages we were sent as children, either overtly as comments that were made to us, or covertly in the “role” we were assigned in the family.  And as we grew up, each disappointment or failure got filtered through the lens of these pre-existing scripts.  They’ve been worn into us like grooves into our brains—over and over again, repetition after repetition. 

Considering the economy we’re living in, the foreclosure crisis, offshoring of jobs, etc., many of you can probably relate to the “paycheck-to-paycheck” script.  Say you were building your own business, steadily increasing business, doing better each year, and then the economy crashed and you lost your main client.  And your house lost its value so you became underwater on your mortgage.  So, you hustled around for other clients, and took lower-paying clients just to stay afloat.  Now, you’re working just as hard, or harder (7 days a week, long hours every day), but still, just to stay afloat, you have to dip into savings.   But you’re staying afloat—just barely.  Then, like many Americans have experienced, your whole field suddenly gets off-shored to another country where people will do your job for pennies on the dollar.  All of a sudden, you are completely out of work and have to find another way to support yourself.  Perhaps, now you are in foreclosure on your house and at threat of losing it.

What happens if you listen to the script that says, “no matter how hard I work, or how much I cut back, I will never get out of this paycheck-to-paycheck way of life.”  Your self-esteem goes into the gutter and you feel helpless and hopeless.  You may even go into “globalized” thinking where you see the whole world this way.  The jobs have gone overseas, there are too many people vying for the same jobs, there are too many houses on the market, and “no matter how hard I work, or how much I cut back, …[you know the drill].”  You may even get so low that you feel like giving up.  But really, what are your choices.  If you’ve been working as hard as you have for years, chances are, you’re not ready to just lay down and die.  And if you feel like you might actually hurt yourself, please get to an emergency room or call 911 right away.  There are people who can help you get through that until you can get back into a healthier mindset.  But assuming you’re not quite there yet, but are feeling hopeless and dejected, and feel like you can’t succeed, think about it this way.  Recognize the script that’s being repeated in your head, and how strong it is.  Think about how deeply ground those grooves are in your brain.  But realize that that voice in your head that’s telling you to give up is the “saboteur” or as some call it, “the death instinct.”  This is the part of yourself who is trying to shut you down, to make you fail.  And the script is a lie!  Let me repeat that… THE SCRIPT IS A LIE!  Don’t believe it. 

There is no magic “secret” that makes some people succeed and other people always fail.  You are not doomed to be penniless or always struggling.  There is no magical larger force out there who has deemed you unworthy of success.  The truth is, that everyone is struggling with something, all the time.  Life is hard, it always has been and it always will be.  There are times that are good and times that are bad.  But if you listen to the LIE that says your efforts are in vain, then what’s your option?  Either give up, and shut down (stay in bed, don’t take care of yourself, don’t pay your bills, don’t work), and things get drastically worse than they are now; or stand back up, and take control over the things that you have control over. 

So what does that mean, “take control of the things that you have control over?”  You don’t have control over the U.S. or global economies.  You don’t currently have control over whether or not you’ll have enough retirement savings.  You cannot control where industries send their work.   And you cannot control what the future holds.  So what can you control?  You can control getting out of bed at the same time you would if you had a job (ie., 7-7:30am at the latest).  You have control over your hygiene—shower and dress as if you were going to work every day.  You have control over whether or not you exercise.  You have control over how you eat (your diet).  You have control over how you use your time.  This can be the hardest one when you’re un- or under-employed.  But if you have to, when you get up in the morning and get dressed and eat a good breakfast, sit down and make a list of some ideas you can work on towards that new job or business.  Include on this list any errands you need to get done.  That’s another thing you can control—taking care of your daily living.  And then start doing the items on the list.  I can hear you saying, “but how can I work on writing my book when that won’t pay the bills this month.”   That’s true.  Anything that you have that brings in money obviously needs to be the first thing you do.  But when you’re done doing the things that bring in money and all you’re left with is too much time and nothing to do but fret, it’s easy to get overwhelmed.  Your mind starts flying all over the place looking for solutions--“should I be a dog-walker and a writer, or a veterinarian, or maybe a cop?”  But now your mind is in a panic, not resting on anything for very long, and seeming to hit dead-end after dead-end.  Just try to slow it down, BREATH and focus on one thing that you can do right now.  For instance, working on your book, or researching one of those careers, or going to a networking event.  It’s hard for us as Americans to slow down.  We think we should be able to act in a moment and have an immediate successful result, or we’re utter failures.  But that is not realistic.  These major life changes take time, and if you are going to move in a direction that will be right for you, you need to slow down and focus on the “here-and-now.”  What can you do today? 

The next challenge in a financial or career crisis, is dealing with other people’s comments.  People may say things that are judgmental or insulting, that they don’t mean to be insulting, but reinforce the negative script in your head.  Or maybe they do mean to be insulting.  People can be very judgmental of others who are having a hard time.  It’s almost like there’s an expectation that we should all have money when we need it, and that if we don’t, we must be doing something wrong.  But that presumes that you have control over everything, the employers, the economy at large, the markets, etc.  You don’t have control over that, so it can’t be all your fault.  Our families, especially have the most power to pull the emotional rug out from under us with a single word.  Especially when you are having to lean on them for financial support, they can act like that entitles them to judge you as incapable and tell you what to do.  “Maybe you should go on welfare.”  “What are you spending your money on?”  “Maybe you should move home with me.”  These comments are like a kick in the gut.  And you have to keep your boundaries firmly in place.  Just because you need some help right now, in the moment, doesn’t mean that you are no longer an adult.  It doesn’t mean you are a failure, and it doesn’t mean that you are foolish or irresponsible.  It just means that you are human, and struggling in a difficult economy.  And if your family can’t help you financially, that’s o.k.  You will find a way to survive on your own.  Even living in your car is preferable to giving up your identity as a separate, adult human being.  All you can do is what any of us can do… get up everyday, control the things you have control over, stay focused on the here and now with an eye on figuring out your path for the future, and keep trying.  That’s all anyone can do. 

A financial crisis like this scenario is probably one of the hardest things a person has to deal with.  Their basic needs are threatened, and the helplessness has a tendency to bring back up that negative script, day after day, moment after moment.  So it is a constant struggle to fight it back, and remember that it is a LIE.  Giving into that script would be a self-fulfilling prophecy.  If you shut down, things will get worse.  But if you keep trying it has to get better.  And besides, what else can you do? 

The Vicious Cycle

So here’s how it goes… You feel stressed out, or upset, depressed, sad, angry, or whatever… you have a feeling you don’t like. So all of a sudden you feel hungry. You may be fully aware that you’re not really physically hungry, or you may have even just eaten. But either way, you feel “hungry.” So you eat something. Chances are you don’t go for something particularly healthy. That’s because it’s not physical hunger, it’s emotional hunger. When people are looking to medicate their feelings with food, they go for so-called “comfort foods.” These are foods that we associate with positive emotional experiences, hence the name. From birth, food and love are paired in nursing/feeding by a loving caregiver. Over the course of a lifetime, we each internalize our own unique experiences where food provided some sort of emotional as well as physical nurturing. For instance, as a baby, you may have been given a bottle when you were crying, regardless of why you were crying. In a baby’s little mind, the message gets sent that when I am sad or wet, or angry, or uncomfortable, or lonely, people give me food to make me feel better. When you were a kid, ice-cream likely got paired with happy events or celebrations, as well as “being good,” or having a “good-game.” There are as many examples as there are people. Your “comfort food map” is unique to you.

O.k., so back to the cycle… you might debate whether you should eat something, or you may not think much about it at all. Chances are, there’s at least a little bit of negotiation in your mind. You think, “why not, I haven’t eaten that much today?” “Other people can eat this stuff, why can’t I?” Or, “you know what? Yeah, I’m probably eating to soothe my emotions, but WHATEVER! At least I’ll feel better for a few minutes.“ It’s the WHATEVER that tells you you’ve given in to your internal saboteur, and the saboteur is now fully in charge. So you give in to the urge to eat to feel better, and you eat something that’s probably not all that great for you. So now, you’ve just fed your saboteur, who is also your inner bully, and guess what? The bully is now fully fueled and ready to attack.

You may be aware of the attack that follows, or it may happen on a deeper, unconscious level. Either way, somewhere in your inner world, you’re beating yourself up. You’ve just convinced yourself of all of the horrible, mean things that you think about yourself when your bully is let loose. For instance, ”see, this is why I never succeed at a diet.” “I’m weak! No matter how hard I try, I never succeed.” “I’m such a loser.” “I’ll always be the pathetic, fat little sister, who can’t take care of herself.” Again, your internal bully has its own well-worn script that is unique to you. These are things that have also gotten internalized over the course of a lifetime, originating in childhood and usually getting built upon, layer-by-layer by repetitive experience.

If you think about this internal dialogue, this IS “depression.” You feel helpless, and hopeless. You’re angry and it may come out in your driving or other “safe” ways. But in general, the rage is aimed squarely at your own head, because it’s not “safe” to let it out on those around you. You feel tired, sad, lonely, hopeless, and thoroughly convinced that you are an incapable person. You have trouble getting up in the morning, or getting to sleep at night. You don’t follow through on things that you’d like to do, because you have no faith in your ability to succeed. And now… you feel that much worse than you did before, and all of a sudden, you “feel hungry.” And around it goes again.

You might be saying to yourself, “all of that from eating something I shouldn’t? Or just trying to make myself feel a little bit better?” “It can’t be because of that!” “It must be genetic that I feel depressed.” Or “I’m just not a morning person.” Or “maybe my anti-depressant has stopped working… you know that can happen…” “It can’t possibly be because I gave in to the emotional hunger this one time!” “It’s just a cookie!” WRONG! You know how I know? Because I’ve seen what happens when you STOP the cycle. It’s starts spinning in a positive way.

How do you STOP the cycle? In that moment, when you feel a feeling you don’t like, and you all of a sudden feel “hungry,” you know that it’s emotional hunger, not physical hunger. So you wait. You don’t eat anything. If it’s in the middle of the day, you identify the feeling, understand it, and then go back to work or doing something productive. Even taking time out of your day to go for a run or walk is a better choice. Just don’t eat until your next meal. Then, eat your next meal like normal (no more or less than is healthy). Keeping a food and mood journal where you write down your feelings on one side of the page, and your eating and calories/points, etc., on the other side, is really quite critical to “getting” what I’m talking about. You’ll see it on paper within days of stopping the cycle. The journal also helps because you can write down what you’re feeling, thereby putting it somewhere else (out of your head). And you feel proactive, like you’re in control, on top of things. Write down EVERYTHING you eat. Even if you go out to dinner and overeat, go ahead and write it down. It will help you to see how easily that happens, and identify what you might have been feeling at dinner.

So what if it’s late at night? Well if you haven’t been keeping your food journal for that day, go ahead and get it out and write down everything you ate for the day. Total it up and see how many calories you have left, or if you are over your goal (keep it a healthy goal, folks—not restricting crazily). If you’re way under, then you may need to eat something, but make it healthy. But if you are at your goal or over, think about how you are feeling in the moment. Are you really hungry? Are you tired? Sad? Lonely? Angry? Depressed? Nightime can be the hardest time for people with food issues. During the day it’s generally easier to stay distracted with other things. But then at night, all of the things you are feeling can come crashing in on you. And all of a sudden you feel hungry. But are you really? If you have already had plenty to eat, then maybe it’s time to go to bed. If, for whatever reason you can’t go to bed yet, then whatever you do, stay the heck out of the kitchen. Turn off the T.V., computer, iPad, Kindle, phone, etc. And read a book or listen to music. Just allow yourself to relax and wind down. Get out your journal and write down what you are feeling emotionally. Chances are you may need a page or two—nighttime is tough. And then go to bed.

Now see what happens when the alarm goes off in the morning. My experience has been that when you succeed at not giving in to overeating at night, the next morning, it’s a lot easier to get up on-time. You’ll feel more energetic, more capable, and ready to take on the day. Why? Because by not feeding the saboteur the night before, you fed the stronger, healthier part of your mind. You fed your “SELF”! You’ve made yourself feel stronger, more capable, and in-control, and able to deal with the day ahead. Now start all over again, and do the same thing today, and tomorrow. I know it’s hard, but you can do it. Moment by moment, one day at a time. Remember, giving in to the saboteur is NOT AN OPTION! You feed it just a little bit and it will grow into a monster and take over your life. After consistently sticking to the new cycle for a few days or a week, people notice a dramatic improvement in their moods. They are less depressed. They may be just as stressed as the week before, maybe even moreso. Stressors today are very real and valid and don’t just disappear overnight or sometimes for months. However, people feel better able to deal with the stress and any negative emotions that come up. They feel like they have a floor underneath them. I can’t tell you how many times I’ve heard people say, “my anti-depressant seems to be working fine now.” And it’s the same anti-depressant they thought had stopped working. Here is your new cycle… and it’s not vicious, it’s invigorating and cathartic! And every day, every moment that you stick with it, you get stronger and more confident, building your self-esteem, strengthening your mental muscle, and growing into the best of yourself. You’ll be amazed at how this permeates other parts of your life, and you’ll find things changing all around you too. One seemingly tiny change turns into something MASSIVE!

Copyright © 2013 Sue Brekka

New Groups Forming

The next sessions for my two groups, are set to start the week of March 15th. If you haven't been to my website, or aren't familiar with my groups, here are some brief descriptions: ATHENA A Support Group for Young Women Ages 14-18 The goddess Athena symbolizes wisdom, courage, warfare, power, divine intelligence, skill, and creativity. During the teen years, young women are faced with a fierce internal battle between who they are and who our society, family and friends expect them to be. Amid this internal war, it is easy to lose touch with, and confidence in, these aspects of themselves. Athena is a therapist-led group where young women come together, in a safe place, to discuss any issues that they are facing in their daily lives. They learn that they are not alone—that every young woman faces this conflict in her own way. Together, they can gain confidence and pride in their own identity, wisdom, power, intelligence, skill and creativity. Among the issues we tackle are: Food and Body Image Dating, sexuality and intimacy Bullying Poor self-esteem, lack of confidence Shyness, loneliness and isolation Anxiety and Depression Academic Pressures Or anything else they need help with… and Healthy Mind – Healthy Body A support group for women struggling to create a healthy relationship with food. This therapist-led group provides a safe, supportive place where you can figure out why food became so much more important in your life than just sustenance. You’ll share your struggle with other women locked in the same battle, learn the tools to change, and together, internalize a new, healthier relationship with food. Discussion topics include: •How food became a substitute for love and affection •Using food to shove down/numb out feelings •Building the mental muscle – becoming more mindful of your food choices •Journaling to discover the roadmap of how you use food, so that you can make more conscious choices. •Family and cultural messages about food and body image •The vicious cycle of Depression and Anxiety that results from using food as a drug, perhaps momentarily feeling better, and the self-loathing, regret, shame and panic (or defeat) that follow •Sexuality and Intimacy (as effected by your relationship with food) •And anything else that makes it hard for you to heal... Each group costs $40 per session with an 8 week committment. If you are interested in either group, please contact me as soon as possible. suebrekka@suebrekkamft.net