A New Year’s resolution is something that goes in one year and out the other

“A New Year’s resolution is something that goes in one year and out the other”–Anonymous

New Year’s Resolutions often fade into the background by the end of January. It seems diets are the same way. Lots of excitement week one, and then back to old habits soon thereafter. I think it’s because they come from “I should” statements instead of “I want to’s”.
Lifestyle changes are different. They are born out of our values-what’s important to us at the core. So I have started asking my clients to make a list called the ‘what’s to my advantage list’. Simply put, it’s about stating your intentions, or the vision you have of the life you want to be living. Intentions are about this very moment…not a goal for the future.
Here’s one list that I hope will inspire you to write your own:
In 2012 it’s to my advantage to…

• Be healthy in body, mind and soul
• Eat for enjoyment and fuel; however, not for entertainment, denial, distraction, sadness or because it’s still there
• Stand and sit straight & tall
• Have a strong core: physically, mentally and spiritually
• Choose activity over passivity
• Develop and choose soothing, healthy ways to relax
• Pray
• Meditate
• Contemplate
• Get sufficient, restful sleep
• Have a tidy house; therefore, a workable routine for chores
• Acknowledge my feelings
• Be kind in general and especially to myself
• Be wise
• Be helpful
• Be mindful
• Honor my family
• Cultivate and cherish friends
• Be faithful yet flexible
• Be a good listener
• Be patient without acquiescence
• Speak my mind when it improves the silence; hold my tongue if it doesn’t
• Have a cat

Add some energy and focus to your intentions by posting your list in places you will look at multiple times per day–on purpose. Just having a list on a piece of paper isn’t enough. Get creative with it–Make a vision board, with pictures of you the way you want to look and feel when you are living your intentions. Do your best in each and every moment. At first, you may need to “act as if”. That’s ok—theater can be fun!
In January, we’ll address more actions to take to keep your intentions alive.
Wake up each day and treat it like New Years!
Wishing you and your families a happy, healthy and visionary New Year!

About Ellen N. Resnick, LCSW (Psychotherapist)

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com Ellen is also a skilled couples' therapist. Ellen’s interest in behavior change grew out of her work with people with diabetes in 1990 at California Pacific Medical Center. Ellen is an Assistant Clinical Professor in the department of psychiatry at UCSF where she worked from 1995-2003 specializing in women’s mental health issues and brief treatment. She ran the Cognitive Behavioral therapy group program for women with depression. Ellen continues to supervise psychiatry residents at UCSF. She lectures extensively in the Bay Area. Feel free to email Ellen at Ellen@thoughtfulweightloss.com

      

 

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Beating the Binge: Who’s in control?

According to the National Eating Disorders Association, about 1-5% of Americans binge eat, a disorder characterized by recurrent overeating episodes and loss of control over eating. You know, like when you start out saying, “I’m going to have a muffin;” and two hours later you’ve had four of them, plus a pint of chocolate mint ice cream and a big bag of sour cream and onion chips. Then the guilt, shame, anger and sadness kick in. “I can’t believe I did that- I am such a loser.” You probably vow never to do this again, and sadly, repeat the experience the following night. The distress you feel about your weight or shape is much like the regret an alcoholic experiences after a night of binge drinking. It’s the loss of control that distinguishes binge eating from simply overeating.
Last week Marty, the Healthywage coach, suggested some helpful questions to help determine if you’re a binge eater (see 10/26 blog). He used the guidelines from Overeater’s Anonymous (OA). This model of treatment is called the addiction model of binge eating.
Experts are split as to whether binge eating really is an addiction similar to alcoholism. Healy reports in an LA Times article dated 11/23/09 that brain imaging studies show significant overlap between the brain circuits activated by a drug addict’s “craving” and those of a binge eater pondering an eating jag.
On the other side of the debate, Steven Wonderlich, a University of North Dakota eating specialist, cautions that the brain’s reward circuitry is complex, involved in many behaviors including but not limited to pathological craving. Therefore, we need more research before making this connection conclusive.
What we DO know for certain is that people who binge eat often experience other problems such as anxiety, depression, and relationship issues. Because of these co-existing issues, the treatment is often done by a team of experts including a psychotherapist, psychiatrist, and nutritionist.
Goals for treatment:
1. To normalize eating by sticking to regularly scheduled meals and snacks throughout the day in appropriate portion sizes.
2. To improve emotional well-being by treating the underlying anxiety, depression, shame, poor self-image, self-disgust, and other negative emotions.
3. When necessary, to lose weight.
4. To learn behavioral maintenance strategies once you’ve reached goal weight.
Types of therapies used to treat binge eating:

• Cognitive Behavioral Therapy

CBT looks at how your thoughts influence your mood and resulting food related behaviors. The questions: “What am I thinking? ’What am I feeling?” and “What is it I REALLY need right now?” guide this treatment approach. You learn to talk back to sabotaging thoughts with accurate and healthy responses. Sabotaging thought: “I had a fight with my best friend. I was so upset I couldn’t stop eating the apple pie until it was gone. I don’t even remember eating it all.” Helpful response: “I need to calm down and figure out how to resolve what happened between us. Bingeing on pie will not help mend the friendship and will only make me feel worse about myself.”

• Interpersonal Therapy

IPT for binge eating is based on the idea that binge eating occurs in the context of specific social and interpersonal problems. IPT helps a person face and heal what are called role disputes– when you and at least one significant person in your life have differing expectations of your relationship. IPT also teaches assertiveness skills dealing with how to express and manage grief and role transitions, i.e., loss of a job or relationship. The theory is that you will not use food for comfort if you develop these skills to handle your stressors.

• Dialectical Behavior Therapy

DBT is a comprehensive treatment program based on cognitive and behavioral principles and complemented by the use of acceptance-based strategies derived primarily from Zen Buddhism. DBT teaches you skills to tolerate distress, regulate your emotions, and improve your relationships with others. These skills can reduce the desire to binge eat.
These treatments are sometimes combined with medications such as antidepressants and/or Topomax, an anticonvulsant drug used to reduce binge eating episodes.
Although the treatment options available for binge eating vary, the essential components are to address the underlying thoughts and emotions that trigger your unhealthy relationship with food.

Which method seems best for you?

Ellen Resnick is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com.
You can email Ellen at ellen@thoughtfulweightloss.com
Copyright © 2010 Ellen N. Resnick, LCSW

Exercise the “letting go of perfectionism” muscle

Last weekend I went to a conference on Buddhism and psychology in San Diego. Sharon Salzberg, a well known Buddhist teacher and author about mindfulness meditation and compassion said something that struck me. “”We need to learn to exercise the letting go muscle.” I believe she meant letting go of expectations of how we think things must be in order for us to be happy and accepting “what is” in the present moment, including ourselves.

As a cognitive behavioral therapist specializing in permanent weight loss, I kept listening for a way to tie this into Judith Beck’s concept of building up the resistance muscle, thinking it would be kind of neat to talk about different metaphorical muscles. Beck’s resistance muscle concept is really quite different though– it means the more you resist cravings and resist eating for reasons other than hunger, the more likely you are to lose weight and keep it off for good.
I kept listening and it occurred to me that the letting go muscle was a perfect way to talk about, well, perfectionism.
It’s hard for many dieters to stop struggling, i.e. justifying their actions with self statements like “Oh, this little bit won’t hurt”, “Just this once, it’s been a hard day-I deserve a treat.” For perfectionists it’s often “I blew it by eating the brownie, I may as well just accept I’ll always fail at dieting.” This thinking is also distorted and does not accept imperfection, an impossible standard to uphold. If you wouldn’t tell your best friend this, it’s a good rule of thumb not to tell yourself this either. It only derails your plan to be healthy.
How to let go of the struggle with emotional overeating:

• Accept that, because you didn’t have healthier coping mechanisms, overeating once worked for you. Like a bad relationship, it’s time to move on now. After all, it’s a bad relationship with food and an unhealthy relationship with yourself.
• Accept that it doesn’t matter what led you to use food inappropriately in the past. What matters are the choices you make right now.
• Accept that to lose weight permanently you can no longer engage in the conflict of “Should I or shouldn’t I eat this?” Give yourself no choice but to be healthy.
• Forgive yourself for being human and having weak moments. After all, it’s a firmly ingrained habit– it’s familiar, making it hard to let go of it.
• Don’t punish yourself for not following your plan to the letter of thelaw. Have some flexibility.
• Allow yourself to get back on track right now. If the struggle returns, as it likely will, be watchful to recognize it early on, notice it, and say, “Thank you, but no thank you-I don’t need you any more.”
• Begin letting go all over again.

Some helpful methods for handling stress without food:

• Do diaphragmatic or belly breathing to slow yourself down.
• Slow down long enough to ask yourself the three key questions,
• What am I thinking?
• What am I feeling?
• What is it I REALLY need right now?
• Change the scenery to gain perspective.
• Develop realistic self talk: “I’ll never win the ‘Should I, shouldn’t I struggle’ It will just distract me from taking the steps to a healthier path.” Don’t engage in the struggle.
• Be willing to risk not being perfect. You’ll have setbacks and overcome them instead of not taking steps at all.

Are you exercising your metaphorical muscles?

Ellen is a psychotherapist in private practice in San Francisco and
Redwood City, California. She specializes in Cognitive Behavioral
Therapy and incorporates the use of mindfulness into the treatment of
depression, anxiety, and emotional overeating. She runs a holistic
weight loss program called Center for Thoughtful Weight Loss,
www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com
copyright © 2010 Ellen N. Resnick, LCSW

Ready, RESET, Go!

Here’s another amazing epiphany from one of my clients:

I was 27 years old before I admitted that I was unhappy, and that my unhappiness was largely due in fact to my being large. I was living in a body that made me unhappy, and I was regularly overeating to soothe those negative emotions. As long as I continued that behavior, I guaranteed my own silent misery. After medical scares and romantic disappointments, I finally decided that I was no longer willing to avoid helping myself, and that no one else was capable of saving me.
I contacted Ellen Resnick and began working with her and The Beck Diet Plan. Over the next year I went through a powerful transformation. It was a transformation of thought, of behavior, and of presence. The most noticeable difference for the outside world has been my change in physical presence, but the most powerful transformation for me has been the new mental presence I possess. I used to believe that I ate without thinking. Six weeks into my fitness plan I told Ellen, my therapist, that I did not eat to comfort myself when I was feeling stress. Three weeks after that I received a stressful email from a coworker, and immediately turned to my box of granola for a snack. As I reached for the box I had a revelation. I wasn’t hungry. And that granola wasn’t on my meal plan for the day. I was reaching for it as a direct result of the onset of work stress. I was dumbfounded at this discovery and wondered how many other “hidden” thoughts had led me to unhealthy behavior in the past.
This realization reinforced my need to continue with the healthy behaviors I was adding to my routine (the ones that became default over my previously unhealthy habits.) I continued to make my meal plans in advance, track my caloric intake, and increase my activity levels. But more than 18 months and 68 lost pounds into my efforts I hit one of the biggest roadblocks to my weight loss plan. And the most frustrating part about that roadblock was that it wasn’t just one “thing” that was making it harder for me to stick to my health plan. Simply put, I was in a funk. For the first time in 18 months I saw the scale go up slightly, and then up again. I had difficulty pinpointing the cause of my funk, which in turn made it more challenging to address the issue and correct course. But unlike every other diet I attempted in the past, I did not falter in my efforts to continue on my journey. Many times in the past I had let myself be permanently derailed. This time I knew that I possessed all the tools to turn things around and that it was worth it to persevere.
I had serious powwows with myself, with my diet coach, and with Ellen. I admitted that I felt great (especially compared to 52 pounds heavier.) But I also knew what 16 pounds lighter felt like. And I wanted to be back there, and even take off another 30 after that. Yes, it is scary; yes, I want to be done. But I’m not done, and in fact I never will be “done.” These are life changes I have instituted, and continuing until I reach my goal weight is a challenge that I know I am capable of completing.
I’m now in “RESET” mode. This mantra is reinforcing that I am back in the habit of flexing my “resistance muscle”. For many years I subscribed to a vicious combination of unhappy emotions paired with harmful ways of comforting myself. Now I’ve learned that instead of letting momentum flow between these negative influences, I can instead put energy into resisting temptation. And every single time I successfully flex this resistance muscle, it gets stronger.
I haven’t been able to do this RESET all on my own. My diet coach and best friend has been instrumental in my efforts. She currently texts me the word “RESET” at random points throughout the day. And she’s committed to shaking up her fitness efforts alongside with me. Being accountable to her, as well as to myself, has also been helpful. I’m ten times less likely to eat a cookie after I shoot a quick email to my coach stating “Danger – tempting cookies in the kitchen! They look great but I won’t be eating any of them.” I acknowledge the challenge, make myself accountable for how I handle the challenge, and let others know about this accountability. All of these systems have helped to refocus my energy.
18 months ago I would have believed that gaining back 16 pounds equaled failure. Now I know better, and I know how very worthwhile it is to persevere. I’m going to continue flexing my resistance muscle until it’s the most toned of them all.

Are you pushing RESET?

A special thank you to Kate for sharing her awesome journey. You are an inspiration to the many lives that you touch!

Note: This week the American Diabetes Association is raising money for research through The Step Out walk. Ellen is walking on 10/1/10 to honor her friends, family and clients with diabetes. If you’d like to find out more please click the following link http://main.diabetes.org/site/TR/StepOut/SanFranciscoArea?px=6140016&pg=personal&fr_id=7346

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com
copyright © 2010 Ellen N. Resnick, LCSW

I lost half my body weight and gained my life back!

An inspiring story from one of my clients:



Over the course of my life, I have lost and gained hundreds of pounds. When I would commit to lose weight, I’ve been able to lose 45, 60 and even 80 pounds, only to gradually gain it back over the next couple of years.
A couple of years ago, my physician suggested I undergo a gastric bypass. This suggestion broke through my denial about how out of control my eating was and how my weight gain was at a medically dangerous level. I was clear that I did not want to undergo surgery so I began on my final journey of weight loss. At that time, I weighed 280 pounds on my mere 4’8” body. I needed to lose at least 150 pounds.
Despite having a master’s degree in clinical psychology, I was reluctant to address the underlying emotional issues that were associated with the huge fluctuation in my weight. I knew that in order for this journey to go down a different path, I needed to do the hard work. I don’t mean the eating changes, and I don’t mean the increase in exercise; I mean, the hard emotional work.
I got a referral from a therapist friend of mine, who gave me a pamphlet for the Center for Thoughtful Weight Loss. I began working with Ellen Resnick, LCSW, who uses the Beck Diet Solution as the framework of her cognitive behavioral treatment.
I began working my way through The Beck Diet Solution Workbook and identifying and addressing my sabotaging thoughts. I learned that a hunger pang was not a warning of an imminent demise and that sometimes one must simply pass up unhealthy food…oh well! I also focused on the reasons why I wanted to lose weight every day. I found that having a diet coach helped me to ‘come out’ and be more honest about the genuine struggle that I always shamefully hid from those around me.
In addition to working on the tough emotional issues, I rigidly record my calories and very seldom veer from my healthy eating patterns that I have developed. I do not let others influence or pressure me to eat anything that I do not want to eat. I began to place importance on the company at an event rather than the food that was being served.
My exercise also has contributed to my success. I began running a couple of miles at a time at a very slow pace. To date, I have run eight half marathons; the last one was a trail run with significant hills. I have also run numerous 10K races, consistently breaking my own time records. I also ride my bike, I open water swim in the San Francisco Bay, work out with weights, and have competed in triathlons.
After 2.5 years of persistence in eating healthy, exercising, and most importantly addressing the underlying emotional issues and sabotaging thoughts, I feel that this weight loss journey will be my last one! I have lost 150 pounds, more than 50% of my starting body weight. I am still working on losing the final 5-10 pounds before I begin my maintenance program.
I did set a reward for myself once I reached my initial goal; it was to go to school to become a personal trainer. My classes begin next week and I look forward to supporting others in achieving their health and fitness goals. By helping others, I will also benefit by the constant reinforcement of how far I have come, how much I have learned, and how much I have accomplished in my own journey!

A special thank you to Donna for sharing her amazing journey. She received an incredible reward today—Dr. Judith Beck will be publishing Donna’s success story in her next newsletter. Way to go Donna!

Ellen is a psychotherapist in private practice in San Francisco and
Redwood City, California. She specializes in Cognitive Behavioral
Therapy and incorporates the use of mindfulness into the treatment of
depression, anxiety, and emotional overeating. She runs a holistic
weight loss program called Center for Thoughtful Weight Loss,
www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com

Today my boss yelled at me and tonight I ate a quart of ice cream

The message to self soothe with high fat, high carb comfort foods is everywhere. On our way home from a weekend getaway today, my husband and I stopped in a lovely cafe in Boonville, CA. We saw a card in their gift store that said, “I was sad ‘til I had Lauren’s fries!”
Experts believe 75% of overeating is caused by emotions. People often eat in response to feelings of stress, depression, loneliness, boredom, anxiety, and anger. Even happiness results in excess food celebrations. Emotional overeating leads to weight gain which results in lowered self esteem. Negative self image increases anxiety and depression leading to even more weight gain. The downward spiral becomes a firmly entrenched habit that prevents you from learning effective skills to resolve your emotional distress. In the words of a report from the American Psychological Association, “Weight loss is never successful if you remain burdened by stress and other negative feelings.”
The triggers for emotional eating range from a fight with your boss, spouse, or child; a long commute; an overly scheduled lifestyle to a bout of depression that leaves one feeling hopeless and unmotivated.
The bottom line is you can’t use food to soothe your emotions AND lose weight. Here are some simple, yet effective stress management tools to crawl out of the vicious cycle.
1) Diaphragmatic or belly breathing. Breathe in peace and calm; breathe out tensions and worries.
2) Listen to music and/or dance.
3) Tai chi
4) Yoga
5) Progressive muscle relaxation- Learn the difference between tense and relaxed muscles.
6) Meditation-Try a Jon Kabat Zinn or Pema Chodron CD.
7) Get involved in an art project.
8) Ride your bike. (Take advantage of the remaining weeks of summer.)
9) Walk or jog.
10) Keep perspective. Write down 3 things you’re grateful for daily.
11) Learn to identify, listen to, and change your negative self talk.

When in doubt about what to do, slow down your impulse to soothe with food by walking away from tbe kitchen and use the “pause technique”. Gently grab the hand you eat with; take 3 calming breaths; and ask yourself the following questions: “What am I thinking? What am I feeling, and what is it I REALLY need right now?”

If all else fails, try an anxiety reducing primal scream instead of reaching for the ice cream.

What tools do you use?

My wife’s latest diet is my next rollercoaster ride

Living with a chronic dieter means facing feelings of helplessness with regards to their sabotaging and harmful behaviors. Spouses must face their fears of the consequences that are likely to occur if their soul mate isn’t able to reach and maintain a healthy weight. “Will I be a widow at 55″?” “Will he have a stroke and be unable to work?” “Will we be able to enjoy the rest of our lives together as we planned when we married?”
Even the flip side is rough. One husband commented, “I get nervous when my wife does lose weight because I don’t know if it’s going to stay off. I feel helpless. It’s a roller coaster ride- I get excited when she starts a new plan (eating or exercise); I’m hopeful that she’s finally found what will work for her, and then I’m frustrated when it doesn’t work.”
It’s easy to become frustrated when we see our partners making poor food choices. One spouse said, “I have to constantly remind myself she’s working as hard as she can.” He’s learned that it’s not about the diet per se…in part it’s about what his wife learned growing up. “Her mother made a lot of food, and in those days it wasn’t healthy, but it was comforting.” Today, Scott knows it has a lot to do with their stress levels. “We live in a stressful world–we take care of the house, our jobs, two kids in college. We always have to squeeze everything in, including the gym for stress management.”
Many partners of chronic dieters don’t really understand. They want to help and there’s only so much they can do– and then it backfires. Too much “help” feels like nagging. Too little help feels unsupportive.

Here are some things you can share with your partner:

Helpful:

1) Partners can model good eating habits. Scott said, “I never ate salad before. Now we eat it all the time with chicken or fish.” Instead of getting a burger and fries, he orders nutritious meals at a restaurant, and his wife Carol is more likely to do the same. “If the fries are not on my plate, she’s not feeling badly that she doesn’t have them either, and she isn’t looking for them. We no longer buy a half gallon of ice cream-we buy 100 calorie options. When the package is empty, dessert is over.”
2) Plan ahead to be sure the house is always stocked with healthy choices. You can serve delicious watermelon instead of cake at summer bar-b-ques.
3) Split meals. Carol said, “I like when Scott suggests splitting a meal. I’m so programmed to order my own plate that I often forget that it’s enjoyable to share something and walk away from the table feeling satisfied and not stuffed.”
4) Get intentional and incidental exercise together. Scott and Carol go the gym together most days, in addition to walking more, taking the stairs in a hotel, and having a rule of not using the moving escalator at the airport. Exercising together helps the non-dieter see that the dieter is working hard. Although Scott gets resentful at times of all the money they spend on the latest program, the bottom line is he sees paying for the gym and a trainer as helping to keep Carol motivated. He keeps the end goal front and center–he loves Carol and wants her to live a long and healthy life–with him.
5) Suggest healthy activities casually–”Do you want to go for a walk together?” (instead of “You need your exercise so let’s go for a hike,”)
6) Plant a vegetable garden together.
7) Express appreciation when your partner prepares healthy meals.

8) Offer to do more of the grocery shopping and meal preparation – Keep it healthy
9) Choose a restaurant that has salads and seafood instead of calorie laden Italian or Mexican food.
10) Compliment your partner when he or she has been working hard at the program.
 11) Notice smaller clothing sizes.
12) Don’t pester the dieter. Carol says, “When Scott leaves me be, it helps. If he pesters me, I feel more self conscious. We hate ourselves as it is.”
13) Remind your spouse to put themselves first. Carol says, “It is helpful when Scott reminds me to put myself first….when I want to take care of what I think is another pressing issue. I appreciate when Scott reminds me not to put my food planning or workout on the back burner. I feel as though I’m being given the permission that I can’t seem to always give myself.”
14) Order room service for breakfast on a cruise instead of going to the buffet.
15) Let your partner decide when it’s time to go on a program (even though he might be worried about your health).
16) Offer to go dancing or purchase a video game like “Dance Dance Revolution” as a fun alternative to traditional exercise.
Unhelpful:
1) Don’t eat tempting foods in front of your partner.
2) Avoid saying things like, “Should you be eating that?” “Is that on your diet?” “Aren’t you supposed to exercise today?”
 3) Don’t bring unhealthy foods into the house.
 4) Don’t suggest stopping for ice cream on the way home in the evening or ask “Why don’t we ever have chips in the house?
5) Don’t complain if your partner sets the alarm an hour earlier in the A.M. to exercise.
6) Don’t make your partner feel guilty if they fall off the wagon.
7) Don’t overload your social calendar. Have balance. Carol said:
“It’s hard when Scott forgets that it’s a 24 hour struggle for me…when we make our week overly social, I struggle with planning and making good choices.”
8) Don’t dine out frequently. It’s harder because you often don’t really know how many calories are in the food.
9) Don’t make disparaging comments about overweight people.
10) Don’t track what your partner is eating or if they should be exercising–keep any thoughts or judgments you may have to yourself.
11) Don’t express resentment at the free time your partner is devoting to exercise.
12) Don’t ask, “Are you going on a diet again?” with a sarcastic or disbelieving tone.

What’s helpful for you?

A special thank you to my family, friends and weight loss clients and their spouses who provided their heartfelt input about this challenging topic.

Ellen is a psychotherapist in private practice in San Francisco and
Redwood City, California. She specializes in Cognitive Behavioral
Therapy and incorporates the use of mindfulness into the treatment of
depression, anxiety, and emotional overeating. She runs a holistic
weight loss program called Center for Thoughtful Weight Loss,
www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com

The cheesecake keeps calling me

And this time I have a different answer. 

Last October Carol went to her family doctor with symptoms of heartburn. She was appalled and devastated when the nurse asked her to step on the scale and she saw just how overweight she had become. She had to face the facts — admit she was consuming hundreds of extra calories, snacking on automatic pilot all night long and waking up feeling ill. She’d been in denial of how heavy she had become.
Carol decided to sign up for the weight management program at her gym, hoping the nutritionist was going to give her a magic pill to lose weight. She wanted the dietician to do the work, not her. Her program was to write down and count all her calories. Sadly she thought, ”It can’t be that simple; this can’t be the magic I was looking for.” She thought, ‘It’s not going to work.”
Carol joined calorieking.com and her husband bought her a pocket calorie counting book to carry with her. She realized the types and amounts of food she had been eating were making her obese. Soon she was asking herself, ”Is it worth all those calories?” The old thoughts of “I won’t write down the cupcakes” are gone. Carol knows not writing it down is only lying to herself, and “what’s the point of that?”
When she watched cooking shows in the past and saw the chef putting in a half pound of butter, she used to think, ”Ooh I can’t wait to test that recipe.” Now she watches with different thoughts. Now she says, “Too many calories,” and chooses not to eat it. She got to the point where she’s able to say, ”I’d rather be fit than eat what’s calling me.” Counting her calories proved to be the magic bullet. ”Being mindful of all of your calories really does work,”’ she said.
Carrying something in her purse, like a fiber bar, allows Carol to be out shopping and not hear the pretzel shop or the cinnamon bun store screaming out her name. Now when she has a craving, she reminds herself that she has a finite number of calories left for the day. ”The nice thing about counting calories is I can have it (i.e. a cookie) as long as I’m mindful of how many calories it is and what I have left for the day. Planning ahead is essential.” She tells herself that she still has choices, and doesn’t need to feel deprived as long as she is mindful of portion sizes. She can savor half of a cupcake and feel very satisfied.
At her school picnic last week they served hotdogs, chips, and juice boxes. Even though she doesn’t even like hotdogs, she would have eaten it in the past because she ate on auto pilot. Now, being both mindful and accountable, she chooses her calories wisely. “Would I want those specific calories or would I rather have something I really wanted, in this case going out to lunch with a friend for a Greek salad (dressing on the side of course)?”

What’s calling Carol now is the thought, ”I need to make good choices.” Although she still wants pancakes and waffles for breakfast, she’s choosing the raisin bran cereal with skim milk.
Now she is being called to maintain a program that will allow her to be healthy and to feel good about herself.

What’s calling you?

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com

Ifs, Ands, or Butts

One might think their reasons for straying from their diet plan are reasonable, BUT sabotaging thoughts can be devastating to the person who wants to lose weight. They can be dealt with in a positive way, AND that will make it possible to stay on your plan IF you want to get rid of that big “butt”.“I would have gone to the gym BUT my friend called and asked me to go shopping.” “I was planning to make my lunch and bring it to work, but I didn’t have time to go to the grocery store.” ”I meant to sign up for the meditation class BUT missed the deadline. Maybe I’ll do it next time.” ”I wanted to stay on my diet; BUT when I saw the short ribs on my neighbor’s plate, I just had to have them.”
When you use the word BUT as a conjunction you negate the first half of the sentence. BUT means that although you considered making the healthy choice on your diet, you gave yourself another option.
Dr Judith Beck, author of The Beck Diet Solution, teaches the concept of ” no choice”. She says just because you want
something doesn’t mean you have to have it. If you put exercising, eating only what you’d planned, and managing your stress in the ‘no choice’ category you take away the inner struggle. Its the same concept as brushing your teeth or paying taxes–these aren’t optional. You may not like it or think it’s fair, but you do it anyway to avoid the consequences of not doing it. Who would choose dentures or major fines?
Although it’s important to acknowledge your feelings, you can still do what’s in your best interest by giving yourself no choice when it comes to straying from your plan.
“I have so much to do today AND I’ll have to find a way to prioritize my chores so that I get on the treadmill for a half hour.”
“I’m under a huge work deadline AND I’ll make time for my back exercises because it will help me to feel better. Ugh, I wish I didn’t have to.” It’s OK to express your feelings if you do not let them deter you from doing what you need to do.
“I do not feel like going to the gym AND it’s important that I get my blood pressure down so that I can live a healthy, long life. I want to know my grandchildren!”

Did you ever notice that people with smaller butts say AND?

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss,
http://www.thoughtfulweightloss.com/.

"Feed" Your Feelings or Nurture Your Spirit

Denial is an unconscious coping mechanism that gives you time to adjust to distressing situations.  But when you remain in denial you deny yourself the ability to thrive.

In summer of 2008 Zoe, a then 74 year old woman came to my presentation, “What’s Eating You: Tools for Permanent Weight Loss”.  She told me that her diabetologist had recently informed her “you’ll never get rid of your belly.”  If that wasn’t enough to discourage her, the sleep disorders specialist said, “Since you can’t tolerate wearing the CPAP apparatus for your apnea, you’ll need to lose 65 pounds, but I know you’ll NEVER do that.”  She walked away feeling angry, humiliated, and discouraged, then cancelled her follow up appointment.  Zoe thought, “What’s the use. I’m fat and I can’t change it.”  She felt hopeless about losing weight- she’d been on multiple diets throughout her adult life and each time she lost weight, she gained it back and more.

Unfortunately, the doctors’ words allowed her to rationalize her denial of the severity of her health problems (diabetes, coronary artery disease, stage 3 renal failure, diverticulosis and asthma).  She continued making poor food choices until she reached 252 pounds.  She wasn’t able to take a bath because she couldn’t lower or raise herself in or out of the tub.  Her family was having discussions about installing a walk in tub for $ 14,000.  When I heard her story I realized that Zoe may have been close to reaching her bottom, the place where positive change for a compulsive overeater becomes possible.

I handed Zoe the Beck Diet Solution Weight Loss workbook  and told her that another client of mine had lost 131 lbs using this model.  We discussed what she’d need to do to lose weight and keep it off for good. I asked about her feelings.  Like many people, Zoe said, It’s not about feelings, “I just like to eat.”  I asked her if she’d like to see her granddaughter get married.  In tears, she said “I’ll try the program.” I told her what Jillian Michaels says about just trying–it’s planning to fail.

And so she began.  She worked through the workbook, journaled her calorie counts at each meal and learned to plan ahead.  It seemed her compulsive nature was working in her favor.  She began exercising daily.  As the pounds came off and the clothes got bigger, Zoe felt empowered.

We’d schedule phone sessions. When I noticed she’d sometimes avoid talking about her progress, I’d ask about her level of stress and how she was coping to soothe her anxiety.  Zoe said most days she was able to notice her cravings and allow them to pass by keeping busy with work and other interesting activities. Finally, she admitted that she was having some very tough days. It was then that I learned she is the caregiver for a severely mentally ill son.  She also has job stress as director of a school. Zoe was beginning to make the important connection between her anxiety and unhealthy reliance on food to comfort herself.

We discussed the following strategies for managing stress and calming emotions:  taking a walk or other aerobic exercise, diaphragmatic breathing, progressive muscle relaxation, having a cup of tea, leafing through a magazine, reading and writing emails, calling a friend, completing a task, hugging a friend or family member, taking a shower (completely incompatible with eating)), relaxing in the bath, imagine being with a favorite friend, reading, or watching a funny movie and laughing.

Two years later Zoe has lost 53 pounds. Her insulin needs are less than 1/3 of what they were; her kidney function is stable.  Her doctors are amazed and thrilled with the change in her attitude and behaviors.  Instead of just trying, she is DOING one day at a time.

Zoe’s success story can be yours as well.  Email Ellen at ellen@thoughtfulweightloss.com and learn what to do about What’s Eating You.

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com.

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, http://www.thoughtfulweightloss.com/. You can email Ellen at ellen@thoughtfulweightloss.com.

Copyright © 2010  Ellen N. Resnick, LCSW

 

Clean Your Thoughts Not Your Plate

I imagine that many people would have healthier relationships with their bodies and food if the message instilled at the family dinner table wasn’t, “You can leave the table when your plate is clean”.

We are often our own worst enemies when it comes to negative self talk.   Not only do we beat ourselves up mercilessly with thoughts like, “I’m fat, ugly, not smart enough”, we also have automatic thoughts, right below the level of consciousness that sabotage our efforts at weight loss, i.e., “I’m tired, I need some chocolate to make it through the meeting”, or “I don’t care; it won’t matter anyway”.   Some overweight adults still hear mom saying “Good girls clean their plate.”

In my first blog, I mentioned the three questions I encourage my clients to ask themselves repeatedly–what am I thinking, what am I feeling, and what is it I REALLY need right now?   Here’s how we use the tool at the Center for Thoughtful Weight Loss.  Yesterday, a weight loss client came in and said it was her husband’s birthday. I asked how they’ll celebrate, knowing special occasions have meant relapse in the past, not just extra calories for one meal.  “We’ve decided to have a healthy meal at home because it’s the best present we can give each other.  No need for wine or dessert.  It’ll be a simple delicious meal with some presents on the table.”  A big component of her success is planning ahead for situations that derailed her efforts in the past.  She has a two week training coming up out of town this summer for work.  Her plan is to bring an extra suitcase filled with healthy food choices.  She chose a hotel that is $30.00 extra per night, but has a full kitchen and a gym. Her intention is very clear– “Traveling and the stress of a two week business trip will not sabotage me.”.  While away, she’ll continue to talk with her diet buddy for support and problem-solving. She’ll schedule a phone therapy session with me to talk about grief issues that have sabotaged her for years, but only recently have been addressed without using food to numb out.

She brought in a surf board necklace (see last week’s blog about surfer dude) as a reminder to stay present so that she can catch her insidious sabotaging thoughts and correct them with self honoring, helpful thoughts.  In cognitive behavioral therapy we think about helpful vs harmful thoughts, behaviors, and social interactions. 

When we identify the sabotaging thoughts or what David Burns (author of the best selling self help book Feeling Good calls cognitive distortions), we have the opportunity to change our thoughts and self talk to accurate, realistic, and helpful thoughts, resulting in choices that
are in our best interests.

Here are some examples of sabotaging thoughts and helpful, accurate responses.  You can see which ones help people remain on plan and which lead to more eating to cover up feelings of sadness, worry, boredom, loneliness, anger, shame, and guilt.

  ST  (sabotaging thought): ” It’s okay to have cookies in the cabinet- they’re for treats.”
  HR ( helpful response):  “I need to accept that having unhealthy food choices around is testing myself beyond my ability to resist temptation.  It’s a mistreat not a treat the way I eat these cookies.”
  ST: ” I don’t have to track all my calories – it’s too time consuming”.
  HR:  “Not tracking keeps me from having consistent weight loss – it’s the # 1 tool of successful maintainers.”
  ST : ” Things are hard; I deserve  this double cheeseburger.”               
  HR :  “Things will  still be hard if I give in to this temptation.  Resisting will build up my confidence-I’ll call my friend, John; he’s a great listener, and I need some support and encouragement tonight.”

Sometimes we have to peel the layers of the onion to get to the thought that leads to the emotion that results in overeating.  Sometimes we need help figuring out what the hot thought is and what we need in that moment.

Feel free to email Ellen at Ellen@thoughtfulweightloss.com  if you’d like help figuring out What’s Eating You.

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com.

Copyright © 2010 Ellen N. Resnick, LCSW

Ride the “Crave Wave”

A few months ago a weight loss client came in for a visit.  I couldn’t help but notice something odd looking falling out of her purse. I could only make out what looked to me like straw hair – it seemed like an odd doll for a mom of teen boys to be carrying around. 

My curiosity got the best of me and so I asked what it was.  Out came ‘surfer dude’.  “OMG, that’s amazing,” I said. “He is just perfect”. A few weeks earlier I had taught her Alan Marlatt’s concept of urge surfing, part of relapse prevention nomenclature for addictive behavior of any kind, including compulsive overeating.  If there is no opportunity to “use” Marlatt says, a craving typically lasts for less than thirty minutes.  If there is no opportunity to use, there is no inner struggle, and it’s the inner struggle that feeds the cravings. This is true for everyone, but few people give themselves the chance to prove it.

Ok, so where’s the surfer in this story?

Anyone who has struggled with food cravings knows that there are times that no matter what we do we to fight the cravings, we feel it’s just not possible to resist them.   It’s like trying to stop a waterfall from flowing.  Marlatt says, “Don’t try to stop the flow because you can’t.  Step back and become an observer of the waterfall, or your cravings, impulses, and urges for the peanut M and M’s.  Just watch the cravings come and go without judging yourself for having them.  Don’t berate yourself for your lack of willpower.  Simply use mindfulness (moment to moment, non-judgmental awareness) to experience your urges without giving in to them.  The urge may come very strongly, and still, you simply watch it, describe it to yourself in full detail, and let it go.  Some people think about sending the craving down the river on a bed of leaves.  Others send it off into a bubble in the sky. Still others send it on a conveyor belt and watch it go by.  It may come back; and when it does, simply put it back on the belt and watch it go round again.  Did it change the second time around?  Did you experience your urge exactly the same way or did it get more or less intense?  It doesn’t matter, as long as you are an observer without self judgment.  And if you notice yourself judging, simply say “judging” to yourself and put your judgments on the belt and watch them go by as well. The waterfall may feel like it’s going to come crashing down on you.  Out comes “surfer dude” who teaches you to ride the wave of the craving without getting caught in the undertow of emotions.   Our feelings can be strong sometimes just like food cravings, or urges for alcohol.  Get out “surfer dude”.  He or she will help you observe your emotions without going under. 

You can ride the crave wave!

Keep practicing.  Go out to the ocean and watch what the surfers do when they fall.

Ellen is a psychotherapist in private practice in San Francisco and Redwood City, California. She specializes in Cognitive Behavioral Therapy and incorporates the use of mindfulness into the treatment of depression, anxiety, and emotional overeating. She runs a holistic weight loss program called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. You can email Ellen at ellen@thoughtfulweightloss.com.

Copyright © 2010 Ellen N. Resnick, LCSW

Ellen Resnick's Biography

I began working with people on behavior change in 1990 as a social
worker on a diabetes team at a prominent San Francisco hospital. It
became clear early on that managing one’s diabetes was directly
related to how people manage their lives and, in particular, their
stress. Often, I was seeing very bright people making very bad
choices. I soon became a student in Cognitive Behavioral therapy,
learning how people’s thoughts impacted their moods and behaviors,
including decisions about food, exercise, and managing stressful
situations.

My interest grew and I wrote a talk called “What’s Eating You: Learn
the Tools to Overcome Emotional Overeating”. The ideas seem to have
struck a chord with people. I began to treat depression, anxiety, and
relationship issues and voilà my clients were soon thinking clearer
and making better choices for their health–life affirming, self
honoring vs. self sabotaging and self defeating choices. They were
learning how to manage emotions without numbing out with food.
Fast forward to 2008. Although people were making better choices in
the moment, they didn’t have all the tools they needed to make good
decisions outside their comfort zone, i.e. when traveling, work
meetings (you know–when the large chocolate chip cookies appear after
the sandwiches big enough to feed a family of three), when they are
out with friends, celebrating, bored, lonely, procrastinating, at
their grandmother’s house, or with a ‘food pushing’ friend (“come on,
loosen up-it won’t matter this once.”). So, my next talk emerged:
“What’s Eating You: Ten Skills to Manage Stress and Enhance Well
Being”. People learned the importance of attitude–having hope that
this time they wouldn’t yo-yo because they’d have skills to handle
every situation with awareness of what they needed in that moment.
Soon, I was taking a picture of each of my clients. I’d ask them to
grab the hand that they eat with, leave the kitchen, take some calming
breaths and ask themselves three crucial questions: “What am I
thinking, what am I feeling, and what is it I REALLY need right now?”
Then came the job of building individual toolkits–things each person
could do if they were bored or sad or lonely, etc. My clients got
creative making pretty boxes and binders with ideas for self soothing.
Some chose knitting or jumping rope; others called their friends for
support as needed. The choices are endless IF you are mindful of what
you are needing and can slow your impulse to soothe with food down
long enough to make a self honoring choice. That is the work.
Fast forward to 2010 and I wrote two new talks: one adapted from
Judith Beck’s work that I call “What’s Eating You: Learn the Tools
for Permanent Weight Loss”, and the newest adapted from Susan Alber’s
work that I call “Eat, Drink and Be Mindful : Soothe Your Way to
Weight Loss”. The first talk teaches 42 cognitive and behavioral
skills for permanent weight loss. The second I now refer to as
“surfer dude”. Huh? Ok, surfer dude is about Marlatt’s concept of
‘surfing the urge’ which will be next week’s blog topic. Stay
tuned….


Ellen is a psychotherapist in private practice in San Francisco and
Redwood City, California. She specializes in Cognitive Behavioral
Therapy and incorporates the use of mindfulness into the treatment of
depression, anxiety, and emotional overeating. Her website
is www.ellenresnick.com She runs a holistic weight loss program
called Center for Thoughtful Weight Loss, www.thoughtfulweightloss.com. 
Ellen is also a skilled couples’ therapist.  She is an Assistant Clinical
Professor in the department of psychiatry at UCSF where she worked
from 1995-2003 specializing in women’s mental health issues and brief
treatment. She ran the Cognitive Behavioral therapy group program for
women with depression. Ellen continues to supervise psychiatry
residents at UCSF. She lectures extensively in the Bay Area. Feel
free to email Ellen at Ellen@thoughtfulweightloss.com