Stages of Change

I often say, "change is the only constant". Seems a bit like an oxymoron doesn't it? Think about it for a second... as much as one might like everything to stay the same, it can't.  Change inevitably occurs. Seasons change, days end, relationships develop, recovery and illness evolves. 

There are many aspects of change I could focus on, however this post is going to look at one concept in particular.  A study on breaking smoking habits by DiClemente & Prochaska (1982), revealed a five stage process in understanding change. The five stages are: precontemplation, contemplation, preparation, action and maintenance.  Why is this important?  There are two reasons I want to highlight when it comes to recovery: a) it show that change is a process and b) change is an individual journey, meaning no one can make anyone else change. Let's use a case example to help describe the five stages. 

CASE EXAMPLE: Mary-Loo (M.L.) has been struggling with binge eating for years. If you were to ask her how long she has been struggling, she would not be able to tell you as this behaviour was normal to both her and her family. One day, while at the hospital waiting for her aunt Judith to come out of surgery, a pamphlet on the table caught her eye,  "Eating Disorders: Binge Eating". She picked it up and started to read it. At first, she denied relating to any of the facts presented in the pamphlet, however, as weeks went by, she couldn't help but notice that her behaviours and feelings were indeed quite similar.  She thought to herself, "could I really have an eating disorder? Everyone in my family eats like this." She started to surf the internet to see if she could find any more information on the subject. She came across a therapist's website who specializes in eating disorders. The website described more about the disorder and its common behaviours and feelings. She put the therapist's phone number in her phone and went to work. Throughout the week, she would shift from denying she had a problem to completely agreeing something was going on.  Eventually, she picked up her phone and made a call to set up an appointment to see what else the therapist could say or recommend. She clicked with her therapist right away and saw her weekly.  After a period of time of normalized eating and skill building, ML decided to cut back her sessions to bi-weekly and eventually monthly to maintain her new lifestyle. 

What's going on here? Let's break it down. 

PRE-CONTEMPLATION - This is when a client is in complete denial or is simply unaware there is an issue that needs change. In the case of ML, binge-eating was so normalized, she was unaware that it was a serious issue, and thus, never thought about it changing it. 

CONTEMPLATION - Here, one becomes aware that there is an issue and thinks more about whether or not a change needs to occur.  ML's thoughts after reading the pamphlet shows how she was sifting through the possibility that something more was going on with her relationship with food/weight. 

PREPARATION - After contemplating that perhaps something needs to change, there's a process of collecting information to help figure out what one will do next. For ML, she surfed the internet, read more information and learned where she could go to address her issues. 

ACTION - The act of calling the therapist and going to therapy is how ML took action in changing her distorted relationship with food/weight. This was an ongoing process that included learning and implementing new skills and exploring her underlying issues over a period of time. 

MAINTENANCE - Essentially, this final stage is the process of maintaining the change one has implemented. For ML, she did this by checking in with her therapist once a month.

A few quick points to make as we finish:

• change is not a linear process. ML went from pre-contemplation to contemplation and back again a few times. Also, slips are inevitable in recovery.  It is not uncommon to have to return to an earlier stage (let's say preparation) in order to successfully implement change during the action stage. 
• the only person who can change is YOU. Your mom can't make you change, your doctor can't do it, nor can your therapist.  The work has to come from you. This said, you are not an island and will need people around you to help make the transition. For caregivers, helping a loved one explore whatever stage they are in or letting them know you are there for them when they want/need it is completely okay! Just make sure you aren't doing for them what they can do themselves.
• people will change only when they want to.  No one can force someone into it.
• nothing changes if nothing changes. If ML knew she needed to make a change with her relationship with food and did nothing about it, there would be no change in her relationship with food! 

What stage are you in? What are you willing to do to move into the next stage? 

Communication

For such an important and critical part of relationships, healthy and effective communication skills aren't often implemented.  Notice how I said, "healthy and effective communication skills" and not just "communication skills".  Shooting off an f-bomb to someone may be effective in getting across that you are upset, but it is not necessarily healthy and effective in getting the response you were hoping. Typically, you get the opposite. Here are a few tips:

#1 Don't Interrupt -

Let's start this point off with a joke.

A: Knock knock

B: Who's there

A: Interrupting Cow

B: Interrupting Co...

A: MOOOOOOOO 

Cheesy, I know, but it is effective in demonstrating the process of interrupting.   Person B never got a chance to answer person A as A interrupted B.  Not only is Interrupting considered rude in our culture, it can also be extremely frustrating for both (or more) parties involved. Think back to a time you were talking with someone and were interrupted by them.  How did it make you feel?  Did you walk away feeling satisfied you were heard? Did you leave thinking, "wow, that was some good dialogue" or were you feeling tired and/or annoyed? Remember, the only person you can change is yourself, so next time you're conversing with someone, give them a chance to finish their thought.  If you are being interrupted, assert yourself and say something like, "I feel frustrated when I am interrupted while talking.  Can you please wait until I finish my thought/sentence before responding. This way, we will both benefit by fully hearing each other's point of view". Start practicing the skill of not interrupting in non-heated conversations, then gradually as it becomes more second nature, it will be easier to do when a heated topic arises.

The following scenario will be used for points #2, 3, 4, & 5

Read the following conversation.  Martha (M) and Amrit (A) are talking about how Amrit's eating disorder is having an effect on the family.

M - You never eat with us anymore.

A - That's because you always cook things no one likes.

M - Your father is very concerned. Your sister feels like she can't talk to you anymore.

A - You make me feel so f!@#ing guilty when you say that!

#2  "I" statements - When communicating, speak only for yourself. Even if you know someone feels/thinks the exact same way you do, speak only on your own behalf. When doing so, use "I" statements.  Using the above as an example, Martha could say, "I am very concerned. I feel like I can't talk to you anymore".  She is owning what she is saying and leaves more room for dialogue between her and Amrit as the two people who are in the conversation are both present.  Also, when using "I feel", no one can truthfully state back to you, "no you don't" as you feel how you feel.

#3 Own Your Feelings

No one can make you feel anything.  Own your feelings! If someone does something, and this action stirs feelings within you, it is yours to own and deal with. There could be multiple ways of responding to Martha's comments as opposed to, "You make me feel so f!@#ing guilty when you say that".  For example, Amrit could feel angry, sad, annoyed, indifferent, or even happy in response to Martha's remark.  Regardless of Amrit feelings, a healthy way to respond would be, "I feel (insert feeling) that you can't talk to me anymore".  Use your feelings as an indicator something is going on inside of you.  Identifying, labelling and owning your feelings is a good first few steps in moving forward both in communication and recovery. 

#4 Avoid Absolutes -  Do you 'always', 'never', 'forever', 'all the time'... I doubt it! Absolutes get people nowhere as it can halt the conversation.  It also feeds into the traps of black and white, or all or none thinking.  Take out the absolutes and get into the specifics.  For example, Amrit could say, "That's because you cook with milk and I am lactose intolerant".  Notice how he killed two birds with one stone? He got rid of the absolute ('always' and 'no one'), in addition to using the 'I' statement around being lactose intolerant. 

#5 Semantics - Swearing often shuts people down and/or raises their backs. If you want individuals to hear what you are saying and to actually considerate it, swear words, exaggerations and tone need to be in check.  People are likely to respond in healthier ways when they are communicated in a approachable way. Think of a dog for a second.  Are you more likely to pet a dog who has a mean loud aggressive bark, who is bearing its teeth or the one that is calm, smiling and wagging its tail? Amrit is not likely going to get his needs met by adding in the word, 'f!@#ing' in his speech to his mom. Keep in mind, just because someone approaches you with swears, aggression and bearing teeth does not automatically mean you must respond the same way. You are in control of yourself.   

#6 Ask! - When in doubt, ask for clarification! If you are uncertain about what/how something is being communicated, ask for it to be rephrased or repeated.  Asking questions in general is a great way to understand what the other person needs and means!

How do you communicate? Are you finding it effective? 

I'm Afraid to Vacation and of Holidays

I often hear how scary vacations and holidays can be.  People aren't the only ones expressing or perpetuating concern.  Think about advertising for a second... the urge to diet before summer time or the post-Christmas diet to shed holiday pounds. I just want to take a few moments and shed a few reminders to encourage you to trust your body and its set point.  For those who don't know what their set point is, trust your meal plan and the effects of healthy amounts of exercise.  Over time, your body will do the rest*. 

1) Diets Don't Work! It is a trap that does not offer a long term solution. When diets end,  one's weight often returns to its pre-diet range, IF NOT HIGHER. A life style change needs to occur in order to be healthy, instead of a crash course in dieting. 

2) People Tend To Indulge on Vacations/Holidays! Holidays and vacations are typically short term in nature compared to the every day routine of living.  Maybe you are staying at an all inclusive resort for a week or two that offers buffets three times a day.  Yup, you are probably going to eat more than you would at home, BUT when you return, you will likely return to your routine of normalized eating and exercise.  Your body will adjust to this. Also, certain holidays and vacations may include an increase in exercise than your normal day to day routine.   Maybe you end up playing football with the cousins at Thanksgiving or you go for a winter hike before dinner. Again, your body will figure it out.

3) Plan For It! It is okay to go into holidays and vacations with a meal plan. It might not be a great idea to just throw all caution to the wind and hope for the best if throughout the rest of the year you are following a meal plan.  In time, you may feel you are ready to be flexible with this, but there is no shame if you need a more concrete plan going into it.  Remember though, a few extra helpings or desserts is not going to make or break you.  

4) Normalized and Healthy! One of the main goals in working towards a healthier relationship with food is to also incorporate normalization.  'Healthy' and 'normalized' are two different words.  Perhaps eating a special dessert your Great Aunt Ida makes isn't the most nutritious, but it is normal to eat it on such an occasion.  Eating a cultural dish when travelling to different country may be a very different experience for you, but is also normal to do. We miss the point in recovery if we solely focus on healthy eating in and of itself.  Part of being healthy is having a certain degree of flexibility in food consumption.  Do you really want to try that special treat? Allow yourself! Keep in mind, however, that you may not feel the greatest after eating too many.  Enjoy it while still knowing the limit. 

5) Life Beyond Food and Weight! Disordered eating/eating disorders and low self-esteem or body-image has already taken too much from your life! Go, make memories, create experiences. Don't let your shape and weight get in the way.** Play on the beach with your loved ones in your swim suit... Have fun!

*make sure to consult your doctor if rapid weight loss or gain occurs to rule out any other medical issues

** sometimes travelling is not advised due to medical complications or risks. Consult your doctor and treatment team around this

Eating Disorders in Sport Conference - Missouri

 It has been a busy spring with much of my non-client time spent either attending conferences on eating disorders or participating in book events for wITHIN. This past weekend, I drove to St. Louis, MO to attend the first ever Eating Disorder in Sport Conference. The conference was hosted by the Victory Program at McCallum Place, Dr. Kim McCallum, Dr. Ron Thompson and Roberta Trattner Sherman, gurus in understanding athletes and eating disorders. 

The conference looked at the importance of treating athletes with eating disorders in a specialized format as sport is a large part of their identity, lifestyle, career and passion. The type of athletes specifically discussed at this conference were competitive, collegiate or Olympic level as well as adult.  I say this because treatment incorporating eating disorders and athletes is in its early stages and research has not specifically looked at outcomes geared towards adolescents and sport as of yet.   Often times in treatment, there is a tendency to want to remove all exercise or greatly reduce it without fully reintegrating it back into their treatment due to a number of reason (i.e.: insurance runs out leading patients to return home without having address this issue, lack of recreational therapists, clients discharging him or herself, etc).   In the early stages of treatment, reducing movement and exercise is necessary until one becomes medically stable again as eating disorders can effect electrolytes, blood pressure, weight, heart, etc.

I want to make very  clear that it is important to not return to exercise until medically stable and cleared by a physician, willing to comply to the nutritional requirements while gradually increasing exercise and are monitored by a treatment team. 

Here are some points I took away from the conference:

• sport in and of itself do not cause eating disorders. There are many who enter sport who do not develop eating disorders and many who are not in sport who do
• coaches are not to be blamed in the development of eating disorders.  Often times, the most intense body pressures and judgment comes from one's teammates. Both coaches and teammates need to be informed and encouraged to use positive body language in and out of the change room. Often times within sport, there is a lack of information as to how such normalized talk about the body and weight within sport culture can be unhelpful and unhealthy
• body politics play into sport, especially for females. There has been an increasing trend for women athletes to wear attire that has more to do with sex appeal than it does to enhance the mechanics of their sport. Check out the differences in attire between male and female runners in running and beach volley ball. Not only is there a pressure to perform well in sport, increasingly there is pressure to look good as well, which indoubtedly affects one's body image and body esteem
• exercise is shown to increase cognitive functioning, quality of life, decrease anxiety and depression, increase bone density
• athletes have two senses of body image: outside of their sport and within their sport
• sexual abuse within sport is high 
• each athlete who is incorporating sport back into their life during treatment must be viewed on a one on one basis as each case and demands of their sport is different
• athletes have two families: sport family vs outside of sport family. Each need to be included in treatment of eating disorder
• many skills within sport (i.e.: goal setting, "coachability", practice, psychological reframing etc) can be used in their recovery from their eating disorder  

To learn more about athletes and eating disorders, check out Ron and Roberta's book, "Eating Disorders in Sport" and the Victory Program at the McCallum Place. 

"The Crazy Project"

A friend of mine passed along a post on Facebook about an initiative on mental health called, "The Crazy Project".  Always on the look out for avenues to raise awareness and reduce stigma around mental health, I was instantaneously intrigued. 

I responded tor the request for personal stories and was invited to participate in the project.  What I like about this project is that it uses photography to capture who is affected by mental health.  They are people just like you and me. I'm sure if I talked to each participant, we would find even more commonalities, but I know we are joined by two factors: mental health and humanity. I believe each person has the right and is worthy to get help, and what makes me sad is that many people don't due to stigma attached to mental health issues. This often leaves people feeling alone, 'different', confused and overwhelmed. 

I hear all too often how people are afraid to share their story, or even be open about their struggle, out of fear they will be treated differently, misunderstood or rejected. I would be lying if I said this wasn't a risk when speaking out. At the same time, I also hear many people wishing they could hear other people's stories so they would know they weren't alone and could rally together with the hopes of gaining strength in their own journey.  People are making these first steps and are speaking up and out about their experiences. They can be found! And thanks to initiatives and projects like "The Crazy Project", these stories can be found! Interested in sharing your story? Check it out or create your own way to do so! 

wiTHIN in THIS

I wondered by the Bookshelf this afternoon in between clients to scope out whether or not the latest magazine publication of THIS was out.  I have been making such trips, for weeks now, in anticipation of an article featuring wiTHIN.  Today was my lucky day as I noticed its cover was different than the times before!  I quickly flipped through it hoping to stumble across the article instantaneously, as if fate would direct me to its page.  No such luck, so I immediately went to the index. I quickly hurried to page 39, and there it was.  

It seems surreal to read about wiTHIN in an actual magazine, but what I am more curious is whether or not people will be drawn to it? I don't mean this in a self-conscious way, but will people glance at it, see that it's about mental health, and turn away in fright, uneasiness, disinterest or judgment.  I'm okay with the judgment part.  I'm continuing to learn how to accept that people will always judge, and that doest necessarily have anything to do with me! Not everyone will like this story or the message in it, but why the uneasiness or fear? I know the answer to this question. I had the exact same response or stereotype when it came to mental-illness (which is evident in Part 1 of wiTHIN). I held stereotypes about those who would self-harm or hear voices in their head... until I got to know people with such issues on a personal level or evolved and struggled with the same thing. 

It is my hope that through reading wiTHIN, some of those stereotypes will be challenged and broken.  That they will see a person amongst the behaviours and obsessions.  I hope that people allow themselves to relate as opposed to feeling they must distance themselves from the main character.  That they will take a chance and realize mental health is something to be afraid of only if it remains silenced.  Look under the bed and you won't find a monster.  It is only the fear of the unknown that drives people away from one another in fear and hate.  That is one of the reasons why I wrote wiTHIN.  And I hope it is one of the reasons why you choose to read it. To purchase a copy, visit the Bookshelf, Wordsworth, or order online. 

wiTHIN at Toronto Comic Arts Festival (TCAF)

This past weekend I had the opportunity to take part in the adventure of TCAF as wiTHIN was debuting.  I have gone in the past but up until this weekend, I have never been a vender showing off art and material.  Not being an artist myself (I draw stick people!!), but the author of wiTHIN, I found the whole experience to be quite fascinating.  

First of all, there were tons of people, both venders and attendees! Even though it was held at the Reference Library in Toronto, it was crowded.  People who had came on the first day, returned on the second as they had not even reached the second floor of the exhibit.  And of the people who attended, some were in costume, others with funky hair do's and colours, cool tights and interesting tattoos.  Old, young, even sleeping babies! People drove/flew across provinces and over the boarder to attend or participate in this event. The energy in the room was happy and fun, which made selling product quite enjoyable and entertaining. 

It was encouraging as it was the first time wiTHIN made such a public appearance since being available for purchase online.  Through word of mouth and online marketing, individuals came specifically looking to buy the book.  This was encouraging to both myself and Emily McGratten   for a variety of reasons.  For one thing, it is always an honour when people are interesting in buying pieces of art or material you have created, but secondly, that there was a shared passion in the message and purpose of what we were doing. Many people could either directly relate to the message of wiTHIN, knew of someone who had or is struggling,  or felt this was a topic that needed to be talked about more in the open. 

What I also enjoyed about TCAF was the variety in art displayed as well as diversity in experience.  From anime, to screen printing and well-known artists to first time vendors. There was room for us all, and all with a story of some sort to tell! Next up for wiTHIN is the Vancouver  Comic Arts Festival on May 24-25th.  Check it out!

May 6 2014 - International No Diet Day

What would happen if I stood on a milk crate in downtown Guelph, ON, shouting, "HEALTH AT EVERY SIZE" or "CELEBRATE YOUR BODY"?  What about if I shouted, "DIETS DON'T WORK"?  How would people respond?  I imagine some would think, "aw, that's a nice message. Yeah yeah yeah, what we need is self-love...self-acceptance... heard it all before." Perhaps some would think, "Sure, easy for you to say... but I still need to lose a few pounds."  I do know, however, there would be a population of people that would completely agree and who work hard at having a healthy relationship with  their body's shape, weight and size.  Unfortunately, I think this population is the minority, but get excited when I see change... even if it is ever so slight.

I've often commented in my blog, that what I say is counter-cultural.  That it is possible to be healthy at any size as well as unhealthy at any size. Size isn't the issue as it is lifestyle and balance. We spend so much time, energy and emotion trying to measure our worth (and health!) according to our pant size or number on the scale.  We look for quick fixes, immediate gratification and measurements of progress that are mostly external. The message needs to change... and... slowly it is!

Today is International No Diet Day! Different cities and organizations will be delivering the same counter cultural message my clients often hear in the four walls of my office. In downtown Guelph, ON, storefronts are supporting the Wellington-Dufferin-Guelph Eating Disorder Coalition (WDGEDC) by putting up signs with positive body affirmations on them and anti-dieting messages. 

Also, at 6:30pm tonight, there is a screening of 'America the Beautiful II" at the Princess Theatre in Waterloo, which examines the obsessiveness of dieting in our culture as well as weight and size. This event is put on by the WDGEDC and Canadian Mental Health Association. Check for events in your area that speak up against dieting... and if none exist, don't let that stop you!  Think about ways to get involved in spreading this message.  

Slowly, but consistently there is a force and movement that is challenging mainstream society.  One that chooses to not listen to or play by the rules that confine people in self-hate, dissatisfaction and shame. It is a message that promotes self-acceptance, health and a sense of freedom.  We don't have to wait until the rules change to live and think differently.  And I challenge you to start today and  continue to follow through tomorrow and the next day and the next.  How will you celebrate International No Diet Day this year?