One of my favorite holiday experiences as a child was getting to help my mom bake dozens of cookies for the many people she wished to bless them with (family, friends, co-workers, neighbors, etc.). I loved helping her put all the ingredients in the mixer. I would let her do the mixing because the electric mixer scared me at times, but she would then let me come help roll the dough into any cookie size I wanted and place them on the baking sheet. I begin to think about these special memories and the many yummy foods that are associated with them during this holiday season. I know for others though, especially those who are recovering from eating disorders, the holidays can be scary, overwhelming, and down-right difficult to navigate. 

For individuals who struggle with disordered eating behaviors, this time of year can be anything but “merry-and-bright.” We know that eating disorders are complex, in that they impact a client’s mental, emotional, physical, social, and even spiritual well-being. Clients who are in eating disorder recovery report that this time of year feels especially difficult for them, as they might be struggling with family dynamics, busy social calendars, financial strain, social expectations and pressures from others to look “their holiday best,” feeling triggered by the fact that food is the centerpiece of most holiday events, all while trying to regain a healthy relationship with their bodies and food. 

I first of all just want to say, if you are one of these brave people during this holiday season, I see you and deeply admire your bravery. It takes immense courage to wade into the waters of recovery, let alone try to navigate it during the holiday season. Know that your choice is powerful, vulnerable, and beautiful. 

I wanted to share three tips that might help give support to anyone who is choosing recovery during this holiday season or knows of someone who is struggling and could benefit from this information. 

Tip #1: Make Memories By Engaging in Activities That Don’t Involve Food

Food is a beautiful gift of the holiday season, and yet it is not the only beautiful gift one can receive. I would encourage a person in recovery from an eating disorder to intentionally find ways to make memories this holiday season that have no connection to food. One might be surprised how many fun things one can do during this season that have no connection to food or beverages. One could make Christmas cards, go ice skating, decorate the house with lots of Christmas decorations, watch Christmas movies, build a bonfire and look up at the stars, wear fuzzy Christmas pjs, sing Christmas carols, and these are only a few of the options. Find ways this holiday season to make fun memories that don’t make food or beverages the star of the show. 

Tip #2: Use Your Supports for Assistance When Needed

It is ok for anyone to need extra support during this season, and I would encourage a person in recovery from an eating disorder to especially lean on their support team during this time. If you, the person in recovery, are feeling anxious about a holiday function or family gathering, troubleshoot with your support team how best to navigate the event. Talk through ways to help you self-soothe, feel safe, be present, and ask for help when needed. I know of family members who have come up with a code word or signal ahead of the event that the person in recovery can say or signal when and if they are feeling distress or needing assistance. If you are working with a dietitian, discuss appropriate food choices and portions before the gathering so you know how to prepare for the meal. Be open and honest with your support team about where you are at throughout the event and give yourself permission to step away or leave early if the distress becomes overwhelming. Give yourself grace as you attempt to navigate these experiences and lean on your supports as much and as often as you need. 

Tip #3: Remember That Food is Food and You Are You 

It is common for food to be the centerpiece of most holiday gatherings, which can be hard for anyone not to get caught up in the fanfare around the holiday meal. For those who are in recovery from an eating disorder, it can be especially tricky not to equate their worth, value, and esteem based upon how much food they ate at the holiday meal. I would encourage a person in recovery to remember that one, two, even three holiday meals in which you believe you ate too much or too little do not change your value or worth as a human being. You are so much more than the food you eat and the body you encapsulate. Your worth is not determined in calories or pounds. Food can be enjoyed and experienced this holiday season and you can and will continue to be the same you. Food is food and you are you, no matter what. 

For those who are choosing recovery this holiday season, know that you are seen, valued, and toasted to this day. No matter if your holiday season has many highs, many lows, or feels more like a roller coaster, you are brave and enough. Keep working hard and know that you are my heroes this holiday season. 

Written By: Dr. Hillary Gorin, PhD

What to Expect and Why:

This blog series will help you understand what to expect in Cognitive Behavioral Treatment (CBT) for a variety of different anxiety disorders, OCD, and PTSD. No matter what you are seeking help for, it can be very scary to start treatment. I assume most of my patients enter their first appointment with me with anxiety. I assume this for several reasons. 1. You are taking a big first step in your life to change something that may feel impossible to change; 2. Most of my patients experience an abundance of anxiety on a daily basis and new experiences make us all feel anxiety.

My hope is that this blog series helps you to have a better sense of what to expect in your treatment if you choose exposure-based CBT interventions. First and foremost, the first appointment will be a lot of data collection. In order to determine how I can be helpful, I must determine what your problem looks like. You can plan on me asking you a ton of questions. My goal is to determine what diagnoses you meet criteria for (to ensure I can treat those diagnoses) and to instill some hope in you that I can help you. Just like we would hope our doctors would evaluate what is broken before treating a broken bone and then tell us how they can be helpful, I want to use a scientific approach in my practice and give you some hope that the science works. Although a one size fits all approach does not work for everyone, I apply all evidence-based techniques or techniques that have been supported by ongoing research. In this series, you will find the general what’s and why’s of treatment with me. Also, if you are struggling with the motivation to get started, I include some information on why it may be worth it to take a chance on this treatment.

Generalized Anxiety Disorder Treatment 

What is it?

Essentially, Generalized Anxiety Disorder (GAD) is chronic worry (American Psychiatric Association, 2013). I often describe it as the tendency to get on the hamster wheel of worry. Worries spin around and around, continuing to fuel anxiety. If you are diagnosed with this, you will also be experiencing the physical impact of this anxiety, such as sleep difficulties or muscle tension. 

What will we work on? 

1. Exposure work: Exposure therapy entails learning to “sit with” anxiety as opposed to avoiding it  (Zinbarg et al., 2006). Avoidance fuels the worry cycle. For instance, many times, chronic worriers will think about something frightening, such as “what if I lose my job?” or “what if a loved one gets sick?” and then they try to push that thought out of their head. In GAD treatment, instead of pushing the thought out of your head, we are going to learn to both tolerate the worry and to tolerate related uncertainty. Sitting with worry requires seeing the worry through to the end. You can expect me to ask you “what happens then?” and “what happens after that” if the worry comes true. We will work to see your worry through to the end by developing what are called worst case scenario scripts. When we watch scary movies over and over again, we eventually become desensitized to them. That is the goal of your treatment. Tire out worry brain so that you can return to the present moment. 

2. Cognitive Strategies: I will ask you to become a scientist (Zinbarg et al., 2006). What evidence do you have for and against the worry? If the worry may come true, how bad would it be? How would you cope? These are questions we will process. We will cope with everything that comes our way, even hardships and tragedy. My goal for you is to start to accept and learn that. My goal is for you to develop more faith in your abilities to manage whatever comes your way.  

3. General Coping Strategies: Relaxation is good for all of us (Zinbarg et al., 2006). However, it does not typically put an end to worry brain alone. We will discuss the practice of healthy relaxation habits to incorporate into your daily practice but I will not encourage relaxation during anxious moments. Instead, I will ask you to take a look at your anxiety, sit with it, and move on. 

Why Engage in this treatment?

Consider the ways your life has been negatively impacted by worry. Consider the time you have lost to worrying (Grayson, 2014). Does your worry solve problems or cause more? Does it impact your relationships? Does it impact your ability to enjoy the present moment? If so, you may want to give treatment a try. 

Why this treatment works? 

Reassuring yourself has not worked, thus far. So maybe it’s time for a new approach. Sometimes, we just need to accept that bad things might happen. This treatment aims to give you tools to cut off the worry cycle, to tire out worry brain, and to re-activate rational thinking brain.  

​References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Grayson, J. G. (2014). Freedom from Obsessive-Compulsive Disorder: A personalized recovery program for living with uncertainty. Berkley Books. 

Zinbarg, R. E., Craske, M. G., & Barlow, D. H. (2006). Mastery of Your Anxiety and Worry: 
Therapist Guide (2nd ed.). Oxford University Press.