By Claire Cusack, B.A., Lab Manager
 
“If you would only stop thinking, you would be much happier”
―Pavilion of Women, Pearl S. Buck
 
Individuals with eating disorders are often bombarded with negative thoughts, both eating disorder specific and general. Some thoughts may resemble worry and others rumination. Yes, there is a difference between worry and rumination! Though worry and rumination are similar negative thinking patterns (Fresco et al., 2002),
 

• Worry refers to an uncontrollable, sequence of negative thoughts, whereas
• Rumination refers to brooding about negative thoughts and feelings (Ellis & Hudson, 2010; Papagerogiou, 2006).

 
Worry is usually repetitive negative thoughts about the future, and rumination is usually repetitive negative thoughts about the past.  In other words, worry is characterized by “What if’s” and rumination is characterized by “Why’s.”
 
What if I fail? Why did I say that?
What if I gain weight? Why can’t I eat normally?
 
At some level, everyone worries and ruminates, even those without eating disorders, and worry and rumination may be adaptive! For instance, concern about an upcoming test may motivate you to study, to reflect on a time that things didn’t go as well as you hoped, or may help you do things differently next time. However, for individuals with eating disorders who also show anxious and depressive symptoms, the thoughts may become unhelpful (Smith et al., 2018). This is where you may get stuck. Have you ever kept circling over an event and have gotten nowhere?
 
Have you asked yourself things like:
​

​Repeating these thoughts may make them seem true or like your fears are inevitable. The good news is that 93% of worries do not come true (LaFreniere & Newman, 2020). When worries do come true, it’s often because we make them come true or what happens turns out to not be as bad as we thought it would.
 
For example, before you know it, you’ve spent so much time thinking that you haven’t checked in with your friend about how they actually interpreted what you said. Or, you’ve spent so much time worrying about failing, that you didn’t study for the test. These sorts of behaviors in response to thoughts may actually cause a rift in the friendship or a low grade. Indeed, it is easy to get trapped in these cyclical negative thought patterns and believe them. These thoughts may make it more difficult to concentrate, do daily activities, or focus on the present (Paperogiou, 2006). Moreover, you may believe that these thoughts are valuable (Behar et al., 2009) and help you (Ellis & Hudson, 2010), such as by avoiding weight gain, or make you feel better (Schmidt & Treasure, 2006). What makes rumination even more insidious is it doesn’t always appear like “negative” or brooding thoughts. Reflecting on food, weight, and shape can lead to eating disorder symptoms just like brooding does (Cowdrey & Park, 2012). An example may be writing down food intake, thinking about it, and analyzing it (Cowdrey & Park, 2011). Though not obviously problematic, this type of behavior encourages repetitive (and unrealistic) negative thinking that takes you out of the present moment.
 
How do I know if my thoughts are helpful or not?

“Yes” to these questions may suggest your thinking patterns are not serving you. When worry and rumination become unmanageable, people often engage in corrective responses (Rawal et al., 2011). These responses may look like seeking reassurance (e.g., weighing or body checking) and attempting to avoid the negative thoughts (Cowdrey & Park, 2012), which ultimately increases eating disorder symptoms (Rawal et al., 2011). The reverse may be true too, where eating disorder symptoms trigger worry and rumination, thus circling back to more eating disorder behaviors (Smith et al., 2018). The repetitive negative thoughts, eating disorder behaviors, and management of both are exhausting.

​So, what can you do about it?
 
While you may currently be in the throes of an endless loop of worry, depression, and symptoms, you can put a pin it and break the cycle. It may seem counter-intuitive, yet approaching and accepting your thoughts can help you find a way out. This means inviting curiosity into your thoughts. When a thought (or series of thoughts) pops into your head, instead of accepting them as fact, notice them, acknowledge them, and try saying “Maybe, maybe not.” This lessens their power. You might wonder, “Why do I need to approach my thoughts and emotions when I am already constantly thinking?” Certainly, worry and rumination can be near constant and thus, may not seem like avoidance. Ironically, they are forms of avoidance. So, how do you approach a thought or feeling when you feel like you’re already doing that, and in fact, can’t avoid thinking? Surprisingly, this does not involve changing the content of your thoughts, but rather changing the thought processes (Ellis & Hudson, 2010; Watkins et al., 2007). Simply put, you don’t have to change what you’re thinking about, but how you’re thinking about it. Here are some suggestions when encountering repetitive negative thoughts:
 

• Acknowledge and Accept. Try noticing the thought and emotions; acknowledge them; and watch them pass without engaging in an eating disorder behavior. For instance, if the thought is “What if I get fat?” Acknowledge the feeling: “I feel scared.” Reframe how you are thinking: “I notice that I am scared.” Instead of avoiding food, approach food by eating the meal or snack anyway. Cycling through a litany of “What if’s” is a strategy to avoid the fear of weight gain.

 

• Take a step back from the thoughts, take a step into the feelings. Entertaining an endless list of “What if’s” or pondering an equally exhaustive list of “Why’s,” may lead you to get lost in the details and forget the purpose. It’s challenging to see the big picture with that level of scrutiny. Taking a step back may provide you with room to acknowledge the feelings. For example:

 
When giving a presentation at school or at work, you might slip on your words. If you catch yourself wondering “Why did I do that? Did they notice? Everyone must think I’m incompetent,” you can take a step back from the thoughts by acknowledging them. “I think that others think less of me because I made a mistake.” Taking a step into the feelings may look like, “I feel embarrassed.” Remembering the big picture could look like, “Even though I messed up a few words, the audience was still able to follow my presentation. Everyone makes mistakes.”
 

• Tune in to your body. This does not mean evaluate and judge your body, but instead to listen to your body (Park et al., 2011). It may be helpful to consider this as a shift from “doing” (e.g., ruminating and worrying) to “being” (e.g., how do you feel in this moment). As worry is typically future driven and rumination is typically past-driven, it can be helpful to focus on the present moment. Taking an inventory of the five senses may be a place to start. What can you see, hear, feel, taste, smell right now? Other activities that have been found helpful for worries include relaxation skills (Hoyer et al., 2009), meditation (Course-Choi et al., 2017; Eberth & Sedlmeier, 2012), and yoga (Zoogman et al., 2019).

 
Here are three take-aways: 
 

1. Not all of your thoughts are facts.
2. Most of your worries are not likely to come true.
3. You can create peace with your thoughts.

 
This doesn’t mean you won’t think negative thoughts or experience uncomfortable emotions. This is a hope that by shifting the way you think, you can not only face uncomfortable emotions, but you create room to feel the happier ones, too.

​Brenna Williams, B.A.
 
“To be beautiful means to be yourself. You don’t need to be accepted by others. You need to accept yourself.” – Thich Nhat Hanh
 
When you look in the mirror, what do you think about your body? How do you picture yourself in your mind? Do you feel comfortable with your body shape, or do you feel self-conscious about the way your body looks? Do you think you have a realistic perception of your body, or is the way you see your body distorted? The way you answer these questions represents your body image.
 
Body image is formally defined as how we feel about our own bodies and our physical appearance. People with a positive body image have realistic perceptions about their bodies. They also accept their bodies or feel comfortable in their own bodies. On the other hand, people with a negative body image have distorted perceptions of their bodies, and they feel shameful, anxious, or self-conscious about their bodies. In other words, people with a negative body image do not see their bodies realistically and they are dissatisfied with their bodies. If you have a negative body image, you’re not alone! Most people have a negative body image, with up to 72% of women and 61% of men report being unsatisfied with their bodies (Fiske et al., 2014). Having a negative body image can impact our mental health. For instance, body dissatisfaction is related to lower self-esteem (Tiggeman, 2005), depression (Keel et al., 2001), and disordered eating (Goldfield et al., 2010).
 
The good news is that body dissatisfaction and negative body image do not have to be permanent, and we do not have to change our bodies to like them. Furthermore, you don’t have to like or love your body to have a positive body image! Having a positive body image can involve simply accepting our bodies as they are in the present moment and not letting how we feel about our bodies get in the way of doing the things we enjoy. We can learn to accept and appreciate our bodies as they are right now. Loving or liking our bodies is not necessary. By changing our behaviors and our perspectives we can promote a positive body image in both ourselves and society.
 
Promoting a Positive Body Image in OURSELVES:

• Focus on the healthy ideal, rather than the appearance ideal. The healthy ideal is how your body looks when all of your health needs are met, including physical, mental, emotional, social, spiritual, and intellectual health.
• Focus on your body’s functions. Remind yourself of all the things your body does that you are grateful for, such as “I like my hands because they help me draw.”
• Practice self-compassion. When you notice you are feeling badly, instead of criticizing yourself, practice self-kindness. Try saying to yourself, “I accept myself as I am today” when you don’t feel good about your body.
• Notice when you are comparing yourself to others. We usually compare ourselves to others who we perceive as “better” than us (i.e., taller, thinner, more muscular), rather than those we are “better” than.
• Focus on the positives. Remind yourself of the physical characteristics that you do like. List them out, “I like my eyes. I like the color of my hair. I like my legs.”

 
Promoting a Positive Body Image in SOCIETY:

• Listen for and challenge body shame talk. When you hear other people talking badly about their own body, or other’s bodies, try calling out their behavior.
• Notice any of your own negative body talk. Make a pact with a friend or family member to stop talking negatively about your own or other’s bodies, and become aware of how you may talk about your own and other’s bodies.
• Start a “body acceptance” campaign or project. Put up positive body image quotes on Post-It notes in your home, school, campus, workplace, or town.
• Raise awareness. Read and share resources about media literacy, body diversity, body positivity, and Health at Every Size (HAES).

 
Positive Body Image Resources

• Health at Every Size
• National Eating Disorder Association
• The Body Project
• The Body: A Home for Love

 
Please share your own ideas of how to promote a positive body image in both ourselves and society in the comments. We would love to hear your suggestions!

By Caroline Christian- Second Year Graduate Student 
There is a lot of misinformation and misunderstanding about eating disorders in our society, which can make it difficult to get accurate information about what eating disorders are, and what they look like. Stigma, stereotypes, and poor communication from eating disorder specialists have led to a lack of awareness of the reality of eating disorders. Getting educated about eating disorders can help one learn how to best support a loved one with an eating disorder, help individuals stay motivated in recovery, or help with speaking out against institutions and policies that are harmful for individuals with eating disorders. Here I provide and discuss some statistics and facts about eating disorders based on empirical research, both in the United States broadly, and in my home state of Kentucky. 
 
Eating disorders (and disordered eating) are prevalent.

• About 6-20% of individuals in the United States will suffer from an eating disorder at some point in their life (Favaro, 2003).
• At this rate, in the city of Louisville there are roughly ~200,000 individuals with an eating disorder and in the state of Kentucky there are roughly ~900,000 individuals with an eating disorder.
• 91% of college women have reported engaging in dieting to control their weight (Kurth et al., 1995).
• 75% of women reported concerns about weight and shape interfered with their happiness (Reba-Harrelson et al., 2009).
• Eating disorders affect everyone, not just women, including men and ethnic and sexual minorities.

 
Eating disorders are (increasingly) prevalent in adolescents.

• Eating disorders commonly develop during adolescence and early adulthood (Stice et al., 2013).
• 15-19 years of age has been labeled a “high risk” group for eating disorders (Smink et al., 2012).
• Most eating disorders (>90% develop by age 24)
• Eating disorders affect 13% of females by the age of 20 (Stice et al., 2013).
• Children and early adolescents today are reporting higher rates of eating disorder behaviors compared to older generations who went through adolescence in the 1990s and 2000s (Favaro et al., 2009).

 
Eating disorders are chronic.

• Approximately 50% of individuals with anorexia nervosa and bulimia nervosa do not achieve full recovery in treatment (Herzog et al., 1993).
• Of those who do recover, over one third with experience at least one relapse.
• Anorexia nervosa has the second highest mortality rate of any psychiatric illness (only after opioid use disorders).
• Individuals with anorexia are 12x more likely to die than women their age without anorexia nervosa.
• Without treatment, 20% of people with from anorexia will prematurely die from eating disorder related health complications.

 
Eating disorders frequently co-occur with other mental and physical health problems.

• 80-97% of individuals with eating disorders have another psychiatric disorder, primarily anxiety and mood disorders (Blinder et al., 2006).
• Individuals with eating disorders are at much greater risk for attempting suicide, engaging in risky behaviors (e.g., substance misuse), and having other comorbid mental health conditions (Pietsky et al., 2008).
• Individuals with eating disorders are at significant higher risk for physical health complications, such as cardiovascular symptoms, obesity, chronic pain, and infectious diseases (Johnson et al., 2002).

 
Eating disorders are difficult to treat.

• Eating disorders are hard to detect and youth frequently don’t perceive these behaviors as problematic and unhealthy, leading to more difficulty in early identification of eating disorders (Walsh et al., 2000).

• Only between 1 in 5 and 1 in 10 individuals with a diagnosed eating disorder will seek treatment (Hart et al., 2011).
• Treatment is even less common among underrepresented populations.
• Inpatient and outpatient treatment for eating disorders cost more than treatment for other conditions, such as OCD, and many individuals in treatment are at a lower level of care than recommended, due to treatment costs and lack of resources (Streigel-Moore et al., 2000).

 
Eating disorders are underfunded.

• The National Institutes of Health allocates only 93 cents towards research funding for every person diagnosed with an eating disorder.
• This ratio can be compared to $88 for every person diagnosed with Alzheimer’s disease and 81% for every individual with Schizophrenia (National Institutes of Health, 2011).

 
Eating disorders are a silent epidemic in Kentucky crucially in need of resources.

• Based on data collected in the Kentucky Youth Risk Behavior Survey in 2013:
• Rates of eating disorders in Kentucky are significantly higher than the national average.
• 33% of high school students perceive themselves to be overweight, 47% are currently trying to lose weight, 13% fasted to lose/maintain weight in the past month, 7% took pills or supplements without a doctor’s advice to lose/maintain weight in the past month, and 6% vomited or took laxatives to lose/maintain weight in the past month.
• Approximately 1 out of every 10 Kentucky high school students reported engaging in 3 or more disordered eating behaviors.
• Students reporting more than three eating disorder behaviors were 5 times more likely to report feeling depressed in the past year, 6 times more likely to report suicidality in the past year, and 4 times more likely to report being bullied or cyber-bullied in the past year.
• The first and only eating disorder specialty clinic in Kentucky opened in Louisville in 2016.
  • This clinic does not offer residential level of care.
  • The closest eating disorder facility that offers residential care is in Missouri.
• Eating disorder behaviors are just as common, if not more common, than many other risky behaviors (e.g., substance abuse) that are currently prioritized by the Commonwealth.
• There are many screening and early intervention protocols in place in Kentucky schools, primary care, and other community-based service settings to detect substance use and mental health problems, but eating disorders behaviors are rarely, if ever, included in those standardized assessments.

 
These statistics and facts reflect the rather bleak current state of eating disorders. But there is hope! If you are feeling helpless or pessimistic about eating disorders, there are things you can do to help change enact positive change!

1. Call your legislators. If you live in Kentucky, Senate Bill 82 is currently being discussed, which would establish an eating disorder legislative council for the state of Kentucky. To support this bill becoming a law, you can Call 1-800-372-7181, and leave a message for your lawmakers, the Senate Health & Welfare Committee or Senate Leadership. When you call, you can let them know why this is important (You can use all the reasons above!)
2. Learn about eating disorder specialists near you that are doing empirically supported practices. Treatment outcomes are much better when therapists are using evidence-based therapies for eating disorders!
3. Talk to your friends and family members (especially kiddos) about the importance of body acceptance and engaging in healthy eating behaviors (e.g., eating enough food, eating a balanced variety of foods, and eating regularly throughout the day). Research shows that open discussions about and modeling of these healthy behaviors can have a huge impact (e.g., Eliassen, 2011).
4. When you are spending time with friends and family, and especially when engaging in this open dialogue about weight, shape, and eating, try to avoid “fat talk” statements. See our blog on why positive body talk is so important in preventing eating disorders!
5. Spread awareness by talking and posting about eating disorders and the harm that eating disorder stigma and stereotypes can cause. Sharing this message widely will allow us to educate policy-makers, therapists, medical and health providers, eating disorder survivors, and their loved ones about how serious and important eating disorders are. Spreading factual information about the real issues can help us build a huge network of people all fighting eating disorders together!

​While many individuals hope their summer is filled with once-in-a-lifetime adventures, summer is the perfect time to spend dedicated time gaining valuable experiences. Whether this is volunteering in a research lab, interning in a field related to your future career, or planning ahead and doing intensive seminars and preparatory courses, there are many ways for you to take advantage and get ahead. Personally, I did a combination of the three, and this has provided me with invaluable experiences that have shaped my future career interests and helped me to prepare for graduate school. As summer applications begin to open, I have a few pieces of advice, and suggestions for maximizing your summer-break opportunity:

1. Start Early. One of the biggest suggestions I have for anyone interested in participating in summer programs is to do your research early. Many of my programs had applications that opened in late fall, and were due around Christmas. To avoid missing out on the perfect opportunity, know where you would like to apply and keep a log of when all the components are due. Even if they are not due immediately, fall and winter breaks are the perfect time to dedicate to finishing these applications. This way, you can make sure you don’t forget to submit during the busiest times of the semester.
2. Be adventurous. While working all summer may not sound the most fun, there are opportunities across the globe. Whether you become a visiting student in a new city in the U.S., or participate in a summer program abroad, there are a multitude of opportunities to explore a new place. Summer is a great time to do a short program abroad, getting not only internship experience and course credit, but also developing your independence and cultural competency. Many colleges have scholarships or partnership experiences that help you obtain these experiences while maintaining a college budget.
3. Know your financial limits. Because internships are invaluable experiences that primarily benefit you, many are either volunteer or stipend positions. Particularly if you are planning to move to a new city, verify that you have the resources available prior to beginning your adventure. As previously stated, there are many scholarships available through universities to help fund these experiences. It is important to balance experience with budget so that you maintain your financial cushion for the semester. In my experience, I spent two summers receiving a stipend from my internship experience. I also spent one summer doing research part-time while also working part-time. This enabled me to still get my experience while also saving for tuition and other costs.
4. Document your experiences. Keep good notes of your roles in your positions. When applying for graduate school or later positions, you will want to have a careful record of what you worked on and how you contributed. This is a pain to do months after the program ends and you may not remember the details. My advice is to keep a journal or log of your daily/weekly tasks, which you can then consolidate and revise for your CV or interviews. Particularly for clinical psychology graduate programs, you will want to talk about your past experiences in depth throughout your application essays, so it is important to have careful documentation of your projects.
5. Follow your passions. This is the most important advice I have for anyone looking for internships or programs. If you are not interested in a field, you will not be able to maximize your experience. Your time is a valuable resource, so why spend it pursuing something you are not interested in? While looking for programs, do some self-reflection to find out what you really want to do. Use the summer to rule out programs or test out new career paths. Let this summer guide you and shape your focus. Most importantly, whatever you do, pursue the goals you love, and they will guide you into a rewarding career.

 
In conclusion, summer is the perfect time to get ahead. By starting early, you can prevent the April stress of not having a plan and be better prepared to take on your future career. As Sophia Loren once said, “Getting ahead in a difficult profession requires avid faith in yourself. That is why some people with mediocre talent, but with great inner drive, go much further than people with vastly superior talent.”

By: Irina Vanzhula, M.S. 

​Would you like to be happy? Of course! Why wouldn’t you? Most people believe that they must get rid of all negativity to create a better life. Abundant self-help books and websites teach us how to get rid of all negative thoughts and feelings and accumulate positive ones. With a brief internet search, you can find long lists of ideas on how to be happy. If they worked, we would all be very happy, all the time. However, 20% of adults in the US experience depression and 31% suffer from anxiety disorder in their lifetime (NAMI, 2018).  Maybe long-term happiness is not possible and the struggle to obtain it contributes to our unhappiness.

The most common definition of happiness is feeling good. This feeling is usually fleeting, and we put forth a lot of effort to try to hold on it. We chase things that we believe would make us happy, such as more money, a different job, a new relationship, having that “ideal” body, or not having to deal with some problem, such as a physical or mental illness. We spend a lot of time, energy, and money in the search for happiness, such as working more hours to get a new job and make more money, spending time on dating apps, dieting and spending hours at the gym, and looking for ways to control how we feel. We try to avoid unhappiness if at all possible.

Unfortunately, all these strategies only work in the short-term (if they are effective at all) and we find ourselves searching for happiness yet again. This happiness chase is largely unsatisfying and can even lead to development or worsening of depression and anxiety. When we are unhappy, we often believe that something is wrong with our environment or even ourselves. Have you ever thought, “What’s wrong with me? Why can’t I be happy like everyone else?” or “Something is wrong with me because I am so unhappy”? We often believe that if we can’t achieve happiness, we have failed.

Where did we get this idea that we should always be happy? The United States was built on the promise of the “pursuit of happiness” and it is one of the most important goals in Western culture. Our society assumes that happiness is a natural state and that mental suffering is abnormal. Suffering is often seen as a weakness or a character flaw. Instead, suffering is a normal part of life. Negative thoughts and feelings are not your enemy, and most things we value come with a full range of emotions. Having more money or a new job comes with exciting opportunities and new difficulties. A relationship brings love and joy, but also disappointment and frustration.

Psychological pain and suffering are part of being human. Our brains developed to survive, which involves worrying about dangers, to evaluate our surroundings, and be dissatisfied with what we have. We would not have built fancy sky-scrapers if humans several hundred years ago were satisfied about their wooden hut. So many songs, paintings, and other works of art would have never been created if humans were always happy. Enduring difficult emotions is a valuable experience that makes us better individuals. Aristotle used the term catharsis to define emotional healing that comes through experience of one’s emotions.  

The goal here is not to say that you should feel sad all the time. However, instead of chasing feelings of happiness, I encourage you to pursue things that matter to you, with all the array of emotions that may come with them. Instead of a happy life, create a meaningful life worth living. If you think that you have to feel better and get rid of pain and suffering before you can do that, this is not true. You can be experiencing difficult emotions AND pursue your goals at the same time; it doesn’t have to be one or the other.   

Here is how to get started.

1. Accept that you cannot control your thoughts and emotions. Let’s do a brief exercise. Spend a few seconds trying not to think about a beach. Don’t think about the waves or how sand feels under your feet. Don’t think about how the breeze feels on your face. How did it go? Were you thinking about the beach the entire time? Now bring to mind your earliest childhood memory and get a picture in your head. Now try to erase the memory so it can never come back to you again. Were you successful? Can you still remember it? Finally, think of the last time you were sad and someone told you not to be. Did that work? Research actually tells us that trying to control negative thoughts and emotions contributes to more suffering (Wheaton et al., 2017; Beesedo-Baum et al., 2012). Instead, allow them to just be there and you will notice that they will soon pass.

2. Practice acceptance. Acceptance does not mean giving up or resigning to your fate. Rather, it means to see things the way they are instead of wishing they were different. If you are struggling with an illness, accept your reality as it is. You don’t have to like the situation or agree with it to accept it. Try writing about your situation, how it came to be and how it affects you. Don’t avoid discussing difficult thoughts and emotions. Instead of saying “I wish this didn’t happen to me and I wasn’t in so much pain” try “This happened to me and I am in pain now. I don’t like how I feel, and I can still move forward.”

3. Figure out what is actually important to you. A new job may not bring you satisfaction if work and career is not something you value. When thinking about your values, consider which ones are truly yours and which ones are placed on us by society. For example, it may be believed that women should value having family and children. Being skinny or fit is also highly promoted in our society. If you are pursuing one of these or other values, consider where they came from. Also, watch out for self-judgments in case you don’t value something that others expect you to. Be true to yourself. The following links can help you identify your true values. After you have done so, think of several small steps you can take towards those values. 
 
Here are some links with more information on how to practice accepting emotions:
http://thegoodproject.org/toolkits-curricula/the-goodwork-toolkit/value-sort-activity/
https://thehappinesstrap.com/upimages/Long_Bull's_Eye_Worksheet.pdf
 
References
Harris, R. (2008). The Happiness Trap. Trumpeter Books: Boulder, CO.

National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/index.shtml

Beesdo-Baum, K., Jenjahn, E., Höfler, M., Lueken, U., Becker, E. S., & Hoyer, J. (2012). Avoidance, safety behavior, and reassurance seeking in generalized anxiety disorder. Depression and Anxiety, 29(11), 948–957.

By: Caroline Christian, B.S.

As anyone who has recovered from an eating disorder knows too well, the road to recovery is never a smooth one. Seeing someone you care about going through this process can be frustrating and confusing. You want to do your best for them, but often it can be hard to even understand or sympathize with what they are going through. Eating disorder recovery is incredibly hard, and everyone going through this process has to work really hard as they endure a lot of really uncomfortable and scary things. If you are having a hard time understanding what eating disorder recovery is like for your loved one, here are just a few of the reasons why recovery can be so difficult.  
 
Giving up on your eating disorder can often feel like losing a friend, or losing a part of yourself. With other types of therapy it can be easier to want to get rid of the illness. For example, with therapy for depression, there is less motivation to want to keep the depression around, as depression doesn’t make you feel good. This makes it a little easier to stay motivated to kick it to the curb. However, eating disorders are not only an enemy, they can also be a friend (see Brenna’s blog post on When an Eating Disorder becomes a Friend). Even though part of your loved one knows that the eating disorder is holding them back, stopping them from enjoying time with family, ruining their relationships with friends, and keeping them in a cycle of disappointment from unrealistic standards, the eating disorder has also been there for them when nobody else was. The eating disorder gave them something to be proud of, it helped with their anxiety (even if just for a brief moment), and it helped them feel in control when everything else was going wrong. Especially if your loved one has been with their eating disorder for a long time, it can start to feel like a part of them. Disentangling this relationship in recovery can be hard, and it can feel like they are losing a friend, ending a relationship, or losing part of their self. This battle of friend vs. foe throughout recovery can drain motivation and make them feel conflicted and frustrated.
             
Recovery means facing your biggest fears. Another difficult part of recovery is that most of the parts of an eating disorder are designed to make you feel safe and help you avoid (temporarily) scary things. For example, counting calories or avoiding certain foods help prevent the scary or uncomfortable expectation of feeling full, gaining weight, or being judged. But when someone recovers from an eating disorder, they have to face these fears head on. To know what this is like, I want you to imagine your worst fear. Let’s say it is spiders. Now imagine that you have to go into a room full of spiders (or whatever your biggest fear is) every day, and each day there are more spiders and bigger spiders. That’s what eating disorder recovery can feel like. To outsiders, eating certain foods and gaining weight may not seem like a big deal. But when your body is reacting to food and weight like it is a room of spiders, it can be really scary. Having to face your biggest fears isn’t easy for anybody. Your loved one recovering from eating disorders has to put a lot of energy into being courageous in the face of fear, which can be really draining.
 
You have to put effort into recovery all day everyday. Unlike individuals recovering from substance use disorders, who abstain from using all together and can avoid situations where they may be tempted to some extent, individuals with eating disorders can’t abstain from food. We need food to live, our society is built around food, and messages about food are all around us. Because of this, everyday with an eating disorder means confronting food and other scary situations multiple times. Recovery requires putting thought, effort, and strength into recovery everyday, whether it be the thought that goes into following a meal plan, the effort it takes to challenge negative body talk, or the strength to confront, instead of avoid, difficult emotions. The nonstop effort your loved one has to put in to recovery is a huge part of what makes the process so exhausting and difficult.
 
If you have a loved one who is struggling in eating disorder recovery, here are a few words of advice from an eating disorder therapist that may help you be there for them as they push through the inevitable hard times.
 
1. Be patient with the process. Eating disorder recovery can be a slow and difficult. A few months down the road, you may wonder why your loved one is still not eating as much as you’d like, or not hitting goals you have for them. The process of recovery takes a different amount of time for everyone, and pressure from family and friends to get better faster will not speed it up. Try to be patient with your loved one and their own personal journey, and know that just because it has been a long journey, doesn’t mean it is endless.
 
2. Don’t take things personally. You may notice that your loved one is more irritable, tired, or withdrawn throughout their eating disorder recovery. It can be easy to get frustrated with them. Instead of being offended if your loved one doesn’t come to your events or support you like they used to, know that they are going through a lot, and they may not have a lot left to give. Try to do things to give them support and energy, instead of asking more of them.
 
3. Try to open lines of communication. Everybody in eating disorder recovery utilizes their support system in a different way. Some people benefit from talking about it, while some would rather process things on their own first. The best thing you can do is let your loved one know that you are there for them and would love to talk with them if and when they want to. You have to find your own balance in which you are not forcing your loved one to talk about their struggles with recovery, as this can add more pressure and frustration for them, but also not avoiding the topic, because that can feel very isolating.
 
4. Educate yourself. Continue to try to read, talk, and learn about eating disorders. They are much more complicated than just not eating enough, or eating too much. They are complex psychological disorders that researchers are still trying to fully understand and treat. Learning about the disorder and how you can fit in to the picture, will help you be more aware about what your loved one is going through and how to not add stress. For example, not promoting dieting or weight loss around them, as diet culture can make ED recovery more difficult.
 
5. Be encouraging. Most individuals in eating disorder recovery struggle with slip-ups throughout recovery, which can feel really discouraging. Your loved one in recovery is going to be hard on themselves, and they may even feel like a “failure” when this happens, so what they need from you is encouragement. Try to remind them of all the little victories they have throughout recovery. Remind them that you are proud of them and their growth so far, and tell them about all the awesome changes you have already noticed. This can help them feel supported and energized to keep going when it is hard.
 
 
Understanding why eating disorder recovery can be so difficult is an important step to help you better support your loved one through this difficult journey. For more tips on how to support your loved one in various stages of recovery check out NEDA’s advice for caregivers. 

This post was written by Shruti Shankar Ram, who is the EAT lab’s outgoing lab manager and will be starting her PhD program in Fall 2019 under the mentorship of Dr. April Smith at Miami University. Shruti also applied during the 2016-2017 cycle and then again during this past cycle (2018-2019). Miami University was her top choice program. Persistence pays off!

While my time at the EAT lab may soon be coming to an end, it marks the beginning of my graduate school career, and the culmination of a successful round of clinical psychology doctoral applications and interviews. Potential applicants for psychology graduate school programs often need to seek out a lot of information on the application process on their own.
 
Luckily, I had the support and advice from graduate student mentors and professors who helped me on my journey, and I have been able to reflect on some of the things other potential graduate school applicants should know before undertaking the process of applying. Please keep in mind that it is important to consider several factors when deciding which programs to apply for, whether it be doctoral or master’s level programs, but the advice given here will primarily pertain to clinical psychology PhD programs:

1. Research your potential mentor(s) thoroughly, and have as solid of an understanding of your research interest as possible. Especially for PhD programs, it is important to consider your potential mentor more so than the program or university itself, as the work you do in their lab will define your career and PhD training. Spend time thinking about your specific research interests and which mentors will align best. This will also make writing your statement of purpose much easier, and faculty are pretty good at telling when you have a genuine interest in the work and a good fit with their lab. The places I interviewed were the places where my research interests fit best with the research interests of the mentor, regardless of my current skillset or what I'd need to learn after arriving at the program. I think partly this is just because it makes it a lot easier to talk with the mentors about follow-up studies and you're more interested in papers they've probably read as well, so it's just easier to interview. Also be up front with POIs about your research interests, and don't try to change your interests to fit with the lab in the hopes it gets you an acceptance. You're going to be spending several years in this program, so you want to make sure you're doing work you enjoy. Also, they can tell a student who is truly passionate about what they do from one who isn't.
 
2. Make sure you REALLY want it before you apply. The application process for PhD programs is way too stressful to just do it without extensive thought and planning. Despite the common misconception, you do not necessarily need a PhD to treat patients and be a therapist. As I want to pursue a career in research and academia, I only applied to PhD programs in Clinical Psychology. However, if I wanted to primarily be a practitioner, I would have considered a master’s degree such as a Master of Social Work (M.S.W.) or Master’s in Counseling Psychology (M.S. or M.Ed.). A PsyD (Doctor of Psychology) is another alternative to a PhD (Doctor of Philosophy) for those oriented more towards therapy, and offers more opportunities for higher level practice administration and supervision, but does typically involve more debt. Another important consideration is that PhD programs are typically fully funded, but PsyD and Master’s programs are not, but they also accept far fewer applicants because of this. Think carefully about what your long-term goals are and what degree might make more sense for you, your interests, and finances. If being a clinician is your primary interest, opt for a psychotherapy program that's literally half the amount of time and effort. So while you may have more financial debt, you will have less of a time debt. 

3. Talk with anyone in your current department who will advise you. Talk to graduate students, faculty you've worked with, faculty you haven't worked with, etc. Be respectful of their time because everyone is busy, but I asked for as many opinions as I could get. Current graduate students can help you identify potential mentors, assist with  personal statements, mock interview you, and potentially even go over offer letters with you. It can be really helpful and insightful to get the assistance of someone who has been through the same process.
 
4. START EARLY. Everyone that applies to graduate school will tell you to start early, but seriously, start early! Writing statements of purpose and studying for and taking the GRE can be time consuming, so work ahead so that you have everything ready far in advance of your deadline. 

5. DO sweat the small stuff. Psychology PhD programs have an acceptance rate of around 7%. Before I applied, I had no idea it was more difficult to be accepted into a PhD program than it was to be accepted into medical school. Because most PhD programs only accept about 5-8 students per year, and each lab typically accepts one student, even little things can make a big difference in your application. Think realistically to make sure your GPA, GRE scores, strong letters of recommendation, research experience in your CV, and number of posters/publications are up to the standard of the graduate schools you are applying to before you apply. PhD programs are getting more and more competitive, so it is becoming more common for people to take years off to work and get research experiences before applying and entering PhD programs.
 
6. Apply to as many schools and POIs as you can without sacrificing too much of your research interests. As PhD programs are so competitive, it is a good idea to maximize your chances by applying to as many programs as possible. I was advised to apply to at least around 11-15, and I ultimately applied to 13. That may seem like a lot, but with the amount of luck that goes into this process, you need to maximize your chances. It's pretty common to apply to many and then only get 3-5 interviews. There are many individuals with strong applications, but who only apply to 2-3 programs, which considerably lowers their chances. If you have a niche interest, it is a good idea to apply to programs of both your primary and secondary research interest, as long as the labs will allow you to study both. 

7. There's a lot of luck and connections that go into this process. Because PhD programs are so competitive, small things like connections can make a big difference. Potential mentors talk to several students, and sometimes they might want to take all of them but just can't. Network as much as possible by attending conferences and making a note of all talks and poster presentations given by the labs you are applying to – attend them and introduce yourself and your intention to apply to both the P.I. AND their graduate students. Everyone in the lab typically has some say in the application and interview process, so make a good impression and network with all lab members you see from those labs!
 
8. BE RESILIENT. When I interviewed at doctoral programs, a common answer I received when asking potential mentors about what they were looking for in applicants is resilience. The whole process of applying to psychology doctoral programs can be disheartening, and rejection is inevitable – it may take several rounds to be accepted to a program. Not everyone is ready at the same time to start graduate school, so do not be afraid to take time off to get more research experience if needed. I first applied to doctoral programs my senior year in college, and did not get accepted until I applied again two years after graduating and working at the EAT lab during that time. Working at the EAT lab allowed me to develop and refine my research interests and has set me up for success in graduate school, and I have no regrets, no matter how much the initial rejection stung. Initial rejections will pay off in the long-run, as long as you keep working and trusting in the process. 
​
If you are planning to undertake the process of applying to psychology doctoral programs – good luck! Remember to not only work hard, but show yourself self-compassion during this process. It is impressive to even apply for these programs! No matter how difficult it may seem to get into a doctoral program, if clinical psychology and research are truly your career goals, keep working towards those goals and you will get there. Hard work and persistence pay off!

By Irina Vanzhula, M.S. 

Its January, and my social media field is filled with articles about New Year resolutions to change our bodies (i.e., lose weight, gain muscle), ways to achieve such resolutions, and negative and judgmental comments about our bodies. What if instead of embarking on another journey that is likely to result in disappointment and self-hate, we consider a different approach this year: Learning to love our bodies. Consider these facts:
 

1. Despite the plethora of weight-loss treatments, the majority of them do not work or work only in the short term (Bacon & Aphramor, 2014). There is not a single weight-loss study that showed that weight-loss can be maintained long-term (if you find them, consider who is funding that study: it is probably linked to a diet industry).
2. Weight loss and gain is much more complicated than simply diet and exercise. Stress (Chao et al., 2017), sleep (Patel & Hu, 2008), genes (Meisel & Wardle, 2014), medications, and medical conditions, all play a role. Consider that emotional stress from worrying about how you look or physical stress from exercising too much can have the impact on your weight! Our bodies also have a set-point, which is like a thermostat (Lowe, 1987). If you start dieting, your body will perceive it as “starvation time” and will slow down your metabolism to conserve energy.
3. Weight has actually very little to do with your health (Barry et al., 2014). Our brains are designed to seek causal effects, and when we see two things go together, we assume that one causes the other. One of these assumptions is that weight causes health problems. In fact, a third reason, poor nutrition or unhealthy lifestyle can cause both. Studies found that normal weight, overweight and obese individuals who engaged in healthy lifestyle habits like not smoking and exercising had equally low mortality rates (Matheson, King & Everett, 2012).
4. Are self-criticism and body-shaming how you try to motivate yourself to adopt an active lifestyle? This is a terrible motivation strategy. Research shows that weight stigma is associated with worse health outcomes. Before you can make changes in your lifestyle, try to accept yourself where you are.
5. Finally, who says that we need to look a certain way? Body image ideals changed over the years, and voluptuous bodies you see on the paintings by 18th-century artists were considered examples of beauty because having a large body meant you were wealthy and could afford food. Different ideas also exist across cultures. What do you think would happen if tomorrow we all stopped caring about our shape and weight? We would be happier and the diet industry would go out of business.  But “normal” BMI is healthy you say? Not really. Have you ever thought about who created BMI cut-offs? You probably assume doctors, and you would be wrong. BMI criteria were set by the International Obesity Task Force that was funded by the weight-loss drug industry (Bacon & Aphramor, 2014).

 
If you are even slightly persuaded by body acceptance, read on. First, let’s define acceptance. Acceptance does not mean giving in, giving up, or learning to deal with, but rather to perceive something as adequate or suitable and embrace it without judgment. Here are some strategies to get started on the body acceptance path.
 

1. Write down 5 things you like about your body. Maybe you like your eyes, your hair, your teeth, your nails, your smile, etc. If this is too hard, you can instead write down what you are thankful to your body for. Maybe you are thankful that your legs let you work on your feet for long hours, or that your eyes let you look at the computer for most of the day, or that your body was resilient and didn’t get flu this year. I personally am thankful to my body for staying strong through all the hours of hard work I am putting it through during graduate school. You can also post the list next to your mirror, so you can see it every day. It’s only fair to remember the positives about your body when you are thinking about the negatives.
2. Make a list of your body parts (and make sure to include those you criticize a lot) and then write down what function they serve. Don’t like your arms? Think about all that they allow you to do, such as do your work, hug your family, and pet your dog. Dislike your stomach? Consider how it works tirelessly all day to digest the food and provide you with much needed nutrients.
3. Watch your language! We often use very judgmental language when we talk about ourselves and especially our bodies (i.e., “I am fat,” “I am ugly,” “I look terrible”). Before you speak to yourself in such a way, consider, would you say it to a friend or your child? Catch yourself and practice using more neutral language. When rephrasing, be as objective and descriptive as possible, and you can express how you feel. For example, instead of saying “my thighs are fat and ugly” try “I have thick thighs and today I feel upset about them.” Notice how the intensity of your emotion changes when you rephrase.
4. Stand in front of the mirror (you can start with 30 seconds) and describe your body in a neutral way avoiding judgments. Pretend that you are describing your body to someone who can’t see and is painting you.
5. Watch out for other thoughts you have about your body. We often believe that what we think is the absolute truth, but we can’t always trust our thoughts. Challenge yourself to consider alternate possibilities. For example, if in a fitting room you have a thought “I don’t fit in these jeans because I am too fat,” don’t stop there. What are the other explanations? Maybe you brought the wrong size, or this design does not fit you. Even if you don’t believe these explanations at first, continue practicing.
6. Speak out against body image ideal. The research found that thought the process called “cognitive dissonance” people tend to align their beliefs with their actions (Festinger, 1962). So repost those body-positive articles on social media and talk to your family and friends about the negative impact of judgmental body talk.

 
Body acceptance is a process and does not happen in one day. You are used to thinking about your body in a particular way, and it will take time to shift that perspective, but it is definitely possible. Just think of what you can do with the extra time and energy when you are not constantly worrying about how your body looks!
 
References
Bacon, L., & Aphramor, L. (2014). Body respect: What conventional health books get wrong, leave out, and just plain fail to understand about weight. Dallas, TX, US: BenBella Books.
Barry, V. W., Baruth, M., Beets, M. W., Durstine, J. L., Liu, J., & Blair, S. N. (2014). Fitness vs. Fatness on All-Cause Mortality: A Meta-Analysis. Progress in Cardiovascular Diseases, 56(4), 382–390.
Chao, A. M., Jastreboff, A. M., White, M. A., Grilo, C. M., & Sinha, R. (2017). Stress, cortisol, and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight. Obesity (Silver Spring, Md.), 25(4), 713–720.
Lowe, M. (1987). Set point, restraint, and the limits of weight loss: A critical analysis. In Treating and preventing obesity. Johnson, William G., (Ed); pp. 1-37; US: Elsevier Science/JAI Press.
Matheson, E. M., King, D. E., & Everett, C. J. (2012). Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals. The Journal of the American Board of Family Medicine, 25(1), 9–15.
Meisel, S. F., & Wardle, J. (2014). “Battling my biology”: psychological effects of genetic testing for risk of weight gain. Journal of Genetic Counseling, 23(2), 179–186.
Patel, S. R., & Hu, F. B. (2008). Short Sleep Duration and Weight Gain: A Systematic Review. Obesity, 16(3), 643–653. 

By Brenna Williams, B.A.

Think about this: What do you look for in a friend? Maybe you look for someone who is kind and trustworthy. Maybe you think a good friend would always be supportive and lift you up when you feel down. Maybe you search for people who are particularly fun to be around and tell great jokes. Whatever you look for, usually our friends are people who make us feel good about ourselves. But what happens when an eating disorder becomes your friend?

Sometimes people with eating disorders experience an inner critical voice, commonly called “the anorexic voice” or “the disembodied voice” in research (Pugh & Waller, 2016; Pugh & Waller, 2017), but more commonly named “Ana,” “Mia,” or “Ed” by those with eating disorders (Williams & Reid, 2012). While this voice is most commonly found among individuals with anorexia nervosa, it is found among all eating disorders (Pugh & Waller, 2017). This eating disorder voice is not a hallucination, but a perception of thoughts in the second or third person (Pugh & Waller, 2017). It says things like “You’re so fat,” “You have to be thinner,” “You shouldn’t have eaten that,” and “No one will love you unless you are perfect.” It may be difficult to think of this voice as a friend. It’s saying things that would make any person upset. So why do people with eating disorders commonly view this voice as a friend (Williams & Reid, 2012)? It may have to do with the onset of the voice.

The voice develops with the eating disorder, starting off by praising the person for losing weight or restricting their food intake (Tierney & Fox, 2010). Ultimately, the voice assists the person in gaining a sense of control over their lives and reinforces them in their disordered eating behaviors. It also offers support and companionship during a time where many people with eating disorders may isolate themselves from others (Damiano et al., 2015). However, as the eating disorder continues to progress, the voice becomes more critical (Tierney & Fox, 2010). The voice shifts from being a friend to a foe (Williams & Reid, 2012) and begins to repeat harsh words similar to the ones mentioned above. Not only that, but the voice becomes grows even more harsh if the person attempts to recover (Tierney & Fox, 2010). As a result, the voice has been theorized to be a maintaining factor of eating disorders (Pugh & Waller, 2017). The voice could also be a potential reason for the high remission and relapse rates among people with eating disorders (Keel & Brown, 2010; Keel et al., 2005).

​There is hope, however! Researchers are beginning to study the voice in an effort to better understand it (Pugh & Waller, 2017). As we being to better understand the voice, we will also be better able to treat it and potentially reduce remission and relapse rates. It may be difficult to break the relationship with this friend/foe and recover from an eating disorder, but it is possible!

Please tell us about your experience with the eating disorder voice in the comments!