by Dr Rebecca Farnham (PhD)
email: rmfarnham@aol.com website: www.velvet-apple.co.uk
Therapeutic Information Giving is an important aspect of stress management giving an underpinning of knowledge that leads to understanding and self-realisation. This aspect of stress management training can be adapted and utilised to bring about an awareness in the individual that they do not have difficulties with food, rather they have difficulties with stress and are reverting (very often) to a childhood state of need that was placated by food with the mother (usually) plying the child with food as a way of comforting them if in pain or distress, or quieting them if they were being demanding due to boredom etc. Therapeutic Information Giving can also be used to help an individual recognise the stress response within themselves. Once stress triggers and responses are understood resilience tools can be taught and used effectively to help combat stress and the resulting comfort eating. Understanding these triggers and how they relate to food can be charted and explored using a food/mood diary where the day/time, stressful event, stress reaction, hunger level, food eaten, and thoughts/feelings are recorded. Once completed over a period time, at least a week, patterns of eating/stress should emerge, as well as information about what kind of foods are being used to reduce the feelings of stress (Rosch, 2001, p. 27). This information can then be used to help gain understanding within the individual.
Breathing is the core of learning to cope with stress and here the classic technique of diaphragmatic breathing is an essential element that can easily be learnt for great benefits. Not only can breathing be used to reduce tension and anxiety, and eliminate symptoms of stress, but it can also be used to bring about greater awareness of inner experience (Davis (et al.), 2008, 27-40). In relation to someone experiencing stress and needing to fight the urge to comfort eat it can be used with immediate effect. Simply taking a few deep, diaphragmatic breaths as they begin to experience a stressful situation, or thoughts, can help to reduce that stress and therefore the urge to eat. If the experience of stress is more extreme then taking several minutes to go through a breathing exercise incorporating mantras for positive thinking or relaxation such as ‘calm and relaxed’ can be beneficial. In my own experience this simple technique has been very useful and I have used it to reduce my stress and gain control over the urge to eat.
A major cause of stress is negative thinking and negative self-talk and these are major contributors to initiating comfort eating (Rosch, 2001, pp. 97-98). Negative thinking could be a general pessimism about a situation, ‘I’m useless, I’ll never get this job done’, or more specifically about weight, ‘I’ll never lose weight. I’m fat and ugly. It’s all my mother’s fault. She made me eat when I was a kid’. Such thoughts fuel and trigger the stress response and can be dealt with using a variety of stress management techniques that recognise these different thought processes such as those that use Cognitive Behavioural Therapy and Rational Emotive Behavioural Therapy. Thinking errors can take many forms such as Mind reading/jumping to conclusions, for example, ‘If I don’t work overtime I’ll get sacked’, All-or-nothing thinking, for example, ‘She always arrives late’, Blame, ‘’It’s all my mother’s fault’, Fortune-telling, ‘I’ll never lose this weight’ and so on. Such thinking errors can effectively be dealt with using cognitive behaviour coaching by teaching thinking skills and helping the individual to recognise their thinking errors and learn how to interrupt, question, and re-frame them (Palmer and Whybrow, 2007, 99-101). For example, rather than thinking ‘I’ll never lose this weight’, the individual can re-frame this thinking and instead make more positive personal statements, ‘I’m taking positive steps to lose this weight and it will eventually go but I need to be patient and persevere with my efforts’.
Another aspect of stress management is the promotion of good nutrition which is an essential aspect of any wellbeing programme and is particularly relevant to a reduction in stress and comfort eating. Eating a balanced diet and reducing stress levels are essential as nutritional imbalances and the effects of stress can cause food cravings, particularly for carbohydrates and sugars. The brain demands glucose for its survival and its energy supply and most of this glucose will come from carbohydrate in the diet. The brain demands almost one third of our daily energy needs and seeks to maintain and regulate its glucose supply at all costs and is full of sensors for monitoring glucose levels which are particularly dense in a central command area known as the hypothalamus. Researchers have implanted micro electrodes in the hypothalami of dogs and cats and recorded strong neural activity after injections of glucose. They found that cells in the lateral region of the hypothalamus decrease in activity (signalling that glucose levels are sufficient). The level of glucose in the blood, and thus the level of glucose recognised by the brain, is determined by the hormone insulin, produced by the pancreas when carbohydrate is eaten. The role of insulin is to transport glucose into body cells where it provides their energy supply. Each muscle cell and tissue cell could be described as a miniature factory burning glucose to produce heat and to enable us to function. Without insulin our cells cannot receive glucose and we would die. Insulin also has a role in the metabolism of fat cells. In the presence of enzymes activated by insulin, the fat cell is able to absorb excess glucose and fat from the bloodstream as a means of topping up energy levels when the organism needs it. Researchers have recorded agitated brain activity after injections of insulin which lowers glucose levels. Cells in the lateral region of the hypothalamus increase their activity, signalling that glucose levels are insufficient. When brain sensors indicate too low a glucose level, physiological and behavioural adjustments ensue: either the liver releases stored glucose into the bloodstream or the hungry organism searches for food. This is important information for those who suffer from stress and it has long been known that the stress response has a negative effect on blood glucose levels and can cause insulin resistance. For example, in a stressful situation the anterior hypothalamus activates the pituitary gland which then releases adrenocorticotrophic hormone (ACTH) into the blood activating the adrenal cortex. Once activated the adrenal cortex then synthesises cortisol, which mobilises glucose and fats from the adipose (fat) tissues. The pituitary also releases a thyroid-stimulating hormone which stimulates the thyroid gland to secrete thyroxin. Thyroxin also raises blood sugar levels. This mobilisation of glucose and fat is an effort by the body to help it ‘escape from danger’ during perceived threat (Palmer, 2007, 20-23). An unfortunate side effect is a blood sugar and therefore energy imbalance which the body then attempts to correct by craving food, particularly high carbohydrate and high sugar foods as carbohydrates are the only source of energy that the body has (protein is used by the body for building and repair). Overeating and binge eating, usually high in carbohydrate, would cause the pancreas to release too much insulin in order to protect the brain from an excess of glucose. Hyperinsulinism (too much insulin) is a problem, causing blood glucose levels to fall too fast, a situation that will lead to an excessive drive for food. Excess insulin may also provoke a condition known as insulin resistance – insulin becomes unable to fulfil its role in enabling the body cells to receive and use glucose. From this information it becomes clear that in order to maintain blood glucose and reduce cravings both a healthy, balanced diet and the ability to deal with stress are essential to maintain stable blood sugar levels and so reduce cravings which can lead to comfort eating.
By reducing stress levels and teaching a more positive outlook stress management training can effect levels of serotonin which can help reduce comfort eating. Serotonin is a neurotransmitter (chemical messenger) known to be essential for mood stability and feelings of well being and calmness; it controls impulsive and obsessional behaviours, and suppresses the desire for carbohydrate foods which therefore reduces the desire to snack. Serotonin in the brain signals that carbohydrate has been eaten and that no more is required by the body. Serotonin levels can be reduced through stress but can be increased through positive thinking, a tryptophan rich diet, and supplements such as 5-HTP (Rosch, 2001, 64-65, 85, Holford, 2004, pp. 338-339). In order to maintain and increase levels of serotonin any stress management techniques that reduce anxiety and promote positive thinking are useful.
Anger and frustration are another area where comfort eating is used to assuage feelings and here comfort eating can take on a slightly more aggressive form. In an anxiety state the comfort eater may just passively eat whereas those suffering anger or frustration may literally push food into their mouths and eat to excess in an attempt to numb the feelings they are experiencing. In this instance the techniques mentioned above, such as diaphragmatic breathing, the ‘STOP’ technique and re-framing are all useful but a more structured and in-depth approach is probably necessary to build up skills to deal with anger and frustration at a more deep-rooted level. Here the classic stress management techniques for dealing with anger are very useful: breathing techniques (as always), Applied Relaxation, Focusing, Refuting Irrational Ideas, and Anger Inoculation, self-esteem (Davis (et al), 2008).
CASE STUDY
Gary came to me for help with his weight. He told me although he ate a healthy diet and didn’t snack during the day when he got home after a day at work he would eat continually, particularly biscuits and crisps and it was not unusual for him to eat whole packets of biscuits and family packs of crisps. This made him feel guilty and disgusted, made him concerned for his health, and was a major cause of his overweight. Gary had a stressful job, was afraid of redundancy, and lived alone. In Gary’s case he had control over his eating during the day, although he did admit to feeling the urge to eat when problems arose at work. It was clear that Gary was not dealing with stresses at work, had negative thought processes about his future, and often felt lonely once he got home with no one to share his feelings with. In Gary’s case stress management techniques were very successful. We discussed his stress triggers at work and I taught him a number of techniques to deal with these issues, such as when a project wasn’t running smoothly. Useful techniques here were diaphragmatic breathing to deal with the here and now, time management skills, assertiveness training to help him deal with his staff and his boss, and stress mapping to help him see how the relationships at work contributed to his stress. As Gary worked on a contract basis he was continually concerned about his future job and financial security. Useful techniques here were re-framing his negative thinking to help him de-awfulize the situation. One of Gary’s mantras to himself was the very negative and stress-inducing, “What am I going to do once this job is finished? I’ll never find another one!”. Instead of this negative anxiety I helped Gary reform his internal monologue and when he found himself thinking such negative thoughts he would then say to himself, “Stop! When the time is right I will be able to find another job. I will use my time constructively to find another job. I have many skills that an employer needs and I am experienced at what I do.” Gary found this very useful and instead of been ‘bogged’ down with negative thoughts he was able to make more constructive efforts at securing future employment. The evenings were Gary’s most challenging part of the day. As he lived on his own he had no one to talk to about his day and its anxieties and this is where he turned to food to help assuage those feelings. However, as much of Gary’s anxiety came from his thought processes during the day he was able to use the techniques that I had taught him to good effect. His general level of stress and anxiety was reduced and he found that he was turning less and less to food to help him feel better. As Gary craved high fat, high carbohydrate foods I analysed his diet and found that although he ate relatively healthily his protein intake was a little too high which could lead to a reduction in serotonin, essential for mood stability. I advised a more balanced diet with a higher carbohydrate content than he was currently having and less protein. I also advised that given that he was prone to cravings and mood swings he take 5-hydroxytryptophan (5HTP) which would boost his serotonin levels (Holford, 2004, pp. 338-339). It was also important for Gary to maintain his blood sugar levels to prevent mood swings and cravings so I suggested that he have a healthy mid-morning and mid-afternoon snack. Exercise was another important area that Gary needed to address, again this helps to stabilise mood and reduce appetite. In Gary’s case it would also mean that he didn’t spend each evening alone and would perhaps gain a larger circle of friends.
In my own personal experience I have noticed that when I am becoming agitated by thinking about something I find stressful, such as worrying about my new business venture or financial difficulties I reach for the cupboard without even thinking about it. My response to anxious thoughts is an unconscious attempt to assuage those feelings of anxiety by self-medicating with food. What I find surprising is that I reach for the food without having thought about eating. My mind is ticking over with anxious thoughts about aspects of my business for example yet my physical body is on automatic pilot and reaches for the cupboards and I have even found myself eating without realising that I have gone through those physical processes. What I have been able to do is make that link between anxiety and the automatic response, recognising that these thoughts will lead to me reaching for food and this is where stress management can be useful. Recognising the situation is the first step, learning to listen to one’s body is crucial and then applying one or more techniques. In this instance diaphragmatic breathing to ease the tension is very useful to calm the body and receive instant relaxation. Another technique that can be used is reframing one’s thoughts from anxious, negative thoughts into positive thoughts, or thoughts that de-awfulize and de-magnify a specific situation. These simple techniques are often enough to reduce one’s stress levels to enable control over the mind and therefore the automatic response of self-medicating stress with food. Another very simple technique, once the link has been made between anxious thoughts and comfort eating, is simply to say ‘Stop’ as one reaches for the food. This serves to break the unconscious act and begins to reinforce the conscious link between anxiety and comfort eating whilst instantly stopping the act of eating unnecessary food. By learning to manage my stress I have been able to lose 3.5 stones and change my life.
Comfort eating is not about an inability to deal with food it is an inability to deal with emotions and stress. When stress management techniques are brought to bear on this condition, both by addressing the causes of an individual’s stress and those moments when they are thinking about food or reaching for food to self-medicate that stress, then good results can be obtained and normal eating habits resumed.
Bibliography
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