Using Emotions to Help in Recovery

Emotions and Eating Disorders

Individuals with eating disorders often struggle with emotions, and may fear or dread them. They can feel "stirred up" or overwhelmed, without the ability to identify or label the emotion. They may feel incapable of experiencing emotion and have a "dead" feeling inside, unable to celebrate joy or cry over loss. Sadness, anger, loneliness, shame—these seem intolerable. Even positive feelings like happiness can lead to symptoms such as binge eating. The most motivated individuals can find it hard to handle the feelings that come flooding back when they gain weight or give up bulimic symptoms. In spite of the huge toll on their health and happiness, they can feel drawn back to the eating disorder as a way of coping. It's as though they would "rather die than feel."

Clinicians working in this field are recognizing that eating disorders can be a way of handling feelings, and have begun to modify old treatments and search for new ones to address this issue. One of these new approaches to treatment is emotion-focused therapy.

Emotion-Focused Therapy

In emotion-focused therapy, feelings are viewed as inherently healthy and adaptive, and as sources of information and wisdom about one's internal experience and about the world. They highlight what is important and what needs attention and healing. They are also seen as signs of healthy needs and as guides to action. For example:

• Sadness is a healthy response to loss that signals a need to be consoled, and leads us, if we heed it, to seek comfort from another person.
• Anger is a healthy response to betrayal or violation, and leads to setting boundaries.
• Fear is a healthy response to threat, and signals a need to escape danger, and can guide us to run or to engage in appropriate safety behaviors.

In the absence of an emotional guidance system, the eating-disordered individual has an impaired capacity for reading these signals and responding in adaptive ways. "Maladaptive" emotions like shame, rage, self-loathing, hopelessness, and contempt for the self take over. These bury the healthy emotions and lead the individual to seek ways (such as restricting, exercising, or having symptoms) to avoid feeling altogether. This therapy works directly with the emotions that individuals with eating disorders try to avoid—the painful, often shameful feelings that seem too devastating to bear. This is not just talking about emotions, but experiencing them, eventually to be able to have a full range of feelings without fear and without need of the eating disorder to manage.

The emotion-focused therapist adopts the role of an "emotion coach," following the individuals to their important feelings, and guiding them in how to process the feelings. Processing involves working with emotions to:

• Become aware of, label, and express them.
• Tolerate and regulate them, and learn to "self-soothe."
• Reflect on and understand them.
• Transform "maladaptive" emotions with healthy ones.

The therapy has a number of tools for working through and transforming feelings. Among these is the use of "chair work" to identify and process the way these individuals battle themselves internally. The idea is to work with different "parts" of the self that are in conflict with each other (referred to as "splits"). One kind of split is the critical voice that individuals with eating disorders often refer to as their "anorexic voice" or "eating disorder voice," which calls them fat, berates them, and tells them not to eat. Another is the "self-interruptive" split where these individuals block or stop themselves from feeling. A third is "unfinished business," where the lasting impact of old, unresolved wounds from relationships with significant others has become part of the individual's own internal dialogue.

Working through these splits by evoking and processing the feelings associated with them serves to un-stick vicious cycles in therapy: Individuals can move towards a softening of their harsh internal critic and a reduction in their body image distress. They can develop a new capacity for dealing with feelings so they don't have to shut them down. And they can move on from past injuries, losses, and traumas. The processing of the feelings leads to a sense of mastery or confidence in identifying and handling internal experience, which is then a powerful tool in other recovery work, such as changing eating patterns.

Emotion-focused therapy has been found to be effective in treating depression and interpersonal issues, and is now being adapted for the treatment of eating disorders. Clinical experience offers promising results, and research is underway to assess it formally with this population. Individuals experience renewed hope in the possibility that they may improve their eating disorder symptoms while finding new ways to deal with their feelings and manage their internal distress.