Anxiety and fear are core elements that underlie eating disorders and disordered eating behaviors. Research has established that anxiety symptoms almost always precede the onset of eating disorder behaviors and that anxiety disorders are also the most common co-occurring diagnoses present in eating disorders.

Anxiety symptoms also tend to persist long after nutritional restoration or remission of eating disorder symptoms. Our program acknowledges this important link between anxiety, fear and eating disorders. One of the most effective treatment approaches for anxiety-based disorders is Exposure and Response Prevention (ERP).

Exposure and Response Prevention asks you to expose yourself to situations that have previously caused anxiety or fear, then work to prevent the compulsive and often harmful behaviors that you might engage in as a coping mechanism. The goal is to produce anxiety in a gradual, planned manner while demonstrating that the usual reaction is not necessary for that anxiety to decrease and, eventually, go away.

Through real-life and imagined exposures, you learn how to break patterns of avoidance and fear, and gain a sense of increased competence by learning to confront and manage anxiety rather than be controlled by it. This approach occurs through intensive patient and clinician collaboration, is done gradually and intentionally, and is repeated to solidify the experience and allow for learning.

Many individuals recovering from an eating disorder discover that behaviors such as restricting, bingeing, purging and other associated symptoms play a role in self-regulation. Some people may fear that without the eating disorder, they will feel “out of control” or “unable to cope.” To this end, we provide evidence-based DBT psychosocial skills training in the areas of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance.

DBT is a cognitive-behavioral treatment that has been demonstrated to be effective in helping individuals with severe emotional dysregulation, understood as high sensitivity to emotional stimuli, intense response to emotional stimuli, and a slow return to baseline. This may present itself in the form of eating disorder behaviors, self-injury, suicidal ideations and attempts, and feeling impulsive or out of control.

The Reasons DBT skills training program focuses on developing understanding around the meaning and purpose of behaviors that may feel shameful or confusing. It also illuminates that two contradictory ideas can be true at once. For example, even if you are struggling, it does not mean you are an absolute failure in life…you may have a bad day, but can still be working hard on your recovery.

Research indicates that DBT is an effective intervention for many target outcomes, including symptoms of eating disorders, drug use, suicide attempts, and self-injurious behaviors.

While much of our programming is focused on reducing distress and anxiety and making necessary behavioral changes, symptom relief is not enough. Behaviors may subside or resolve altogether, but if the more profound issues are not explored, problems may arise in other areas as different symptoms.

A depth-oriented approach is a way of seeing and understanding. Symptoms are seen as metaphors or indications to pay attention to something deeper rather than only things to get rid of. For example, we often encourage attention to the meaning of and psychological connection between food and body.

As a treatment team, we have a deep respect for the unknown and take a position of curiosity about what lies beyond the symptom. We make no assumptions about family dynamics or history of trauma, but instead explore the issues that enable or hinder a conscious, authentic approach to life. Critical elements of a depth-oriented approach include:

• Honoring the symptom: We focus on reducing shame around the parts of the self that feel “wrong” or “defective.” We are not focused on “fixing” an inherent flaw, but on learning how to pay attention to and nurture an inner sense of self by starting from a place of curiosity about what is being revealed in the symptom or suffering.
• Meaning making: Consciously or unconsciously, meaning is made all day, every day. The recovery process sometimes brings up difficult questions, like “what is my purpose?” or more broadly, “what is the purpose in all life?” We utilize the concept of making meaning to move towards wholeness and integration. We encourage exploring and finding an individually meaningful sense of purpose in life.
• Integration: Meaning-making opens the door to integration. Rather than getting rid of a part of oneself, we encourage exploring the possibilities in life that may have been rejected in service of the eating disorder.

The inner critic is often quite loud, communicating messages of self-hatred, and making it difficult to treat ourselves as a person of worth and value. For those living with an eating disorder, the profound emotion of shame is often a central part of the suffering. Healing comes through dedication and effort on many fronts, including learning to relate differently to our pain.

The practice of self-compassion is an essential part of the journey and impacts much of the work of recovery. Self-compassion has two parts: turning inward to look at our suffering and then taking action to alleviate it. This method of directing loving-kindness and a sense of understanding toward yourself is the antidote to shame, self-criticism, and the resulting suffering that exists in our lives. At Reasons Eating Disorder Center, we incorporate a compassion-focused approach into treatment and offer skills to train the brain to extend compassion toward its inner critic. We explore healing concepts such as mindfulness, acceptance, compassion, and loving-kindness to help cultivate an inner sense of calm, peace, and warmth.

Check out our blog for additional resources on self-compassion: