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Section 12
Track #12 - How to Treat Panic & Guilt by 'Going with the Binge'

CEU Question 12 | CEU Answer Booklet | Table of Contents | Eating Disorders
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed four techniques for redefining hunger for overeating clients.  These four techniques of redefined hunger included:  Recognizing Mouth Hunger Phrases; Hunger Log; Demand Feeding; and Responding to Hunger.

In my experience with binging and purging clients, I have found that after a client decides to give up dieting, he or she will have relapses in his or her behavior. These may be an occasional binge or overeating episode, and the regression itself is not an indicator of failure.  However, the client’s reaction to his or her perceived failure can seriously damage his or her commitment to curing his or her behavior.  Do you agree?

On this track, we will examine three concepts related to binge regression.  These three concepts related to binge regression include:  self-criticism during a binge; panic; and guilt.

3 Concepts Related to Binge Regression

Share on Facebook Concept #1 - Self-Criticism During a Binge
The first concept related to binge regression is self-criticism during a binge. When clients regress into a binge, they are prone to self-criticize themselves. Clients will want to resort to old ways of motivation, such as berating, belittling, and criticizing themselves. They still believe that by feeling negatively about themselves, they can control their actions when in fact they are only exacerbating them. Because a client binges as a result of negative feelings, he or she is creating more and more negative feelings as the self-criticism continues. Instead of slowing down the binge, the client is in fact giving it more steam.

Jody, age 45, had been an avid self-criticizer prior to her treatment. Each time she ate a "forbidden food" she became more and more critical of herself, which worsened her situation.  Jody stated, "I couldn’t understand it! Every time I had a craving, I would do everything in my power to stop myself, but I only seemed to want it more!" 

Because Jody had used self-criticism before to try and stop herself, I believed that she would be more susceptible to revert back to her old coping mechanisms should she regress. During the first week of her no-dieting, Jody felt herself wanting to binge. She stated, "I could tell, because I wasn’t really hungry, but I wanted to eat my old binge food, saltines and jam. I  knew if I ate right then, I would fall into a binge."  We will discuss the technique I used with clients like Jody later on in the track. 

Think of your Jody.  Is he or she vulnerable to self-criticism?

Share on Facebook Concept #2 - Panic
The second concept related to binge regression is panic. When a client realizes that he or she is in the midst of a binge, they begin to feel anxious about themselves and their behavior. Once a client is in the grips of panic, he or she is liable to forget about using more affirmative action and instead begin to criticize and berate. The panic can verge on hysteria and this extra stressor, like self-criticism, can push a client even further into a binge.

Share on Facebook Cognitive Behavior Therapy Technique:  Going with the Binge
Brad, age 34, constantly panicked when in the midst of a binge.  He stated, "I don’t know what comes over me, but I get really edgy and I start telling myself, ‘What are you doing?  You’re ruining everything you’ve worked for!’ but that only makes matters worse!"  To help clients like Jody and Brad keep their binges from becoming too over-the-top, I suggest they try the "Going with the Binge" exercise. 

Instead of resisting the urge to eat, I asked Jody and Brad to try and enjoy the food they were eating.  Prior to their treatment, the foods they had been denying themselves were associated with negative connotations and these negative connotations translated into feelings of guilt and failure which subsequently fed their emotional rollercoaster.  To avoid augmenting those negative feelings, Jody and Brad instead encouraged their binging.  Jody stated, "I was going straight for my old arch nemesis, saltines and jam, when I said to myself, ‘I really don’t even like saltines.  They’re my old binge food.  If I’m going to binge now, at least I should eat something I really love.’" 

Instead of eating the entire box of crackers, Jody pulled out a pint of Ben and Jerry’s.  She stated, "The guilt was gone because I was letting myself do what I really wanted."  To help Jody and Brad with their CBT exercise, I gave them the following List of Instructions:

  1. No more abusive remarks.  If you find yourself criticizing, remind yourself that negative thoughts make you feel bad, and feeling bad makes you want to binge.
  2. Replace your self-criticism with a reminder that your binge is a symptom of anxiety.  Something is making you uncomfortable and you need soothing.  You need compassion, not rebuke.
  3. Tell yourself that you don’t have to know why you’re upset before you can be sympathetic to yourself.
  4. Be as tender and nurturing to yourself during your binge as you possibly can.  Give yourself the foods you really want.

Although this approach may seem strange and counterproductive, I have found that this approach works much better with binging and purging clients than any diet could.  Think of your binging and purging clients.  Could any of them benefit from the CBT technique "Going with the Binge"?

Share on Facebook Concept #3 - Guilt
In addition to self-criticism and panic, the third concept related to binge regression is guilt. After a binge, a client will begin to feel the familiar feelings of guilt and failure they once did. As you already know, these feelings of guilt can lead to purging, which can put the client’s health in danger. I have also found that feelings of guilt are most acute after a binge regression in which a client is going through treatment, but cannot keep him or herself from binging. They believe that they do not have the proper willpower and subsequently feed their own sense of worthlessness.

Jared, age 38, had experienced severe guilt after every binge. These feelings of guilt and failure would cause him to purge the next day, not eating any meals at all which left him vulnerable to another binge. To break the cycle, I asked Jared to give himself a break.  Instead of berating himself after each binge, I asked that he accept his behavior and move on. 

The next week, Jared stated, "I had a bad binge the other night and I woke up in the morning furious with myself! I remembered that trashing myself would only make things worse. So I decided not to criticize myself for feeling desperate. Instead, I forced myself to put on the new suit I bought last week. I continued to eat out of mouth hunger that day, but I was more relaxed about it!  By late evening, I was able to feel stomach hunger again!" 

Think of your Jared. Could he or she avoid the binge-purge cycle by accepting his or her behavior and moving on?

On this track, we discussed three concepts related to binge regression.  These three concepts related to binge regression included:  self-criticism during a binge; panic; and guilt.

On the next track, we will examine three concepts related to the compulsive dieter.  These three concepts related to the compulsive dieter include:  addressing failure; addressing the need to control; and overcoming the need for self-criticism.

Online Continuing Education QUESTION 12
What are three concepts related to binge regression? To select and enter your answer go to CEU Answer Booklet.

 
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