Chicken or Egg
Brain Retraining for Reaching Remission
A member of the forums on this site recently asked about the expression of maladaptive behaviors and whether they originate as thoughts or feelings.
To use a somewhat limiting computer-based analogy, our brains are parallel processors, not serial processors.
The neural system implicated in the expression of anxiety disorders (eating disorders, OCD, phobias, generalized and social anxieties etc.) is the threat identification system and it’s ready to receive and be shaped by innumerable inputs even in utero, and intensively does so from birth onwards.
It incorporates structures in the brain responsible for logical deduction, emotion, biological base-level survival and all those for sensory inputs: sight, pressure, pain, equilibrium, itch, touch, smell, hearing, and internal states of the body.
It's really a bit more like Schrödinger's Cat than it is a nice, neat sequential cascade of neural events.
In fact quantum physics is more how the brain realizes learning. From Ask a mathematician / Ask a physician:
“The “Quantum Zeno effect” or “Turing Paradox” is the idea that if you measure a quantum system repeatedly and rapidly you can prevent it from changing. Kind of “a watched quantum pot never boils” sort of thing.”
A monstrously long but very good article on this topic is Quantum physics in neuroscience and psychology: a neurophysical model of mind-brain interaction.
It doesn't particularly matter how you want to frame the experience of the current psychological condition in question (thought to feeling or feeling to thought); it will be the attention and effort you put towards replacing thoughts, feelings and behaviours with new learned thoughts, feelings and behaviours that will allow you to realize remission.
Ideally your attention is placed on all three in equal measure when you undergo psychotherapeutic brain retraining to recover from an eating disorder.
Brain Retraining
There are as many specialists in the eating disorder field who will assure you that the condition “is not about the food” as there are those who will assure you it “is about the food”. It’s a bit like the nature vs. nurture argument that either your genetics or environmental inputs shape your destiny. Of course, it’s nature via nurture— both are shaping your destiny and acting on each other to change that destiny throughout your life.
An eating disorder is about the food in so far as, while not experienced consciously as such, food has been inadvertently misidentified as a threat by the threat identification system. But it’s equivalently not about the food in that how avoiding food makes you think, feel and behave generates the reinforcement of food avoidant behaviours. Both facets shape your destiny and are acting on each other to change your destiny throughout the entire arc of this chronic condition’s presence in your life.
First and foremost, full refeeding and rest have to be in place before you can attempt any successful brain retraining. But within weeks of stopping all exercise and eating to the minimum intake guidelines, you can begin your brain retraining efforts.
Remission will utterly elude you if you do not incorporate brain retraining into your recovery efforts. It would be nice if refeeding and rest alone just whisked you into ‘normal’, but it doesn’t.
What is brain retraining? It’s the process of attention, learning and practicing. Many psychotherapeutic treatment modalities (approaches) incorporate those three facets. Variation in the modalities has to do with which existing behaviours get attention, and what new behaviours are learned and practiced until they are ingrained.
Most eating disorder patients are best served when their counsellor or therapist is trained in multiple treatment modalities. The treatment modalities with scientific evidence to support their use in treating eating disorders include: exposure and response prevention (ERP), dialectical behaviour therapy (DBT), cognitive behavioural therapy (CBT) and enhanced cognitive behavioural therapy (CBT-e), integrative cognitive affective therapy (ICAT), eye movement desensitization and reprocessing (EMDR), mindfulness based stress reduction (MBSR) and motivational interviewing (MI). These modalities are not one-size-fits-all, so it is best to do a bit of online research on what they entail and what they are best targeted to treat.
If the therapist is steeped in cultural norms that define hierarchies of food (good food/bad food), ‘healthy’ choices, and a weight-centric approach to recovery, then they cannot help patients reach full remission, although harm reduction is likely possible. With such a therapist, you will get quickly mired in “recover but not too much” (discussed in Target Weight) Most counsellors and therapists are neither dieticians nor physiotherapists and it will be your first warning sign that you may not be well supported if your therapist provides dietetic or exercise advice.
Food and rest are central to recovery. So while you don’t want a therapist acting as a dietitian or physiotherapist, you do need them to focus on the fact that food avoidant behaviours are enacted because a) food is misidentified as a threat and b) the avoidant behaviours are also providing a host of other mood- and thought-modulating (short-term) benefits that have to be identified, given attention and addressed as needed.
Therapy should feel a bit like walking into an intermediate class for something in which you are an absolute beginner. The therapist acts as a bit of an interpreter sitting beside you so that you aren’t completely lost in the class and you are given some encouragement despite all the initial confusion you face.
Thankfully, brains are designed for this process. In fact, they even have powerful systems to draw you towards the attention, learning and practice necessary for mastery of any new skill or behaviour.
We crush a lot of the natural pull towards this process in our current educational systems. Given that many with eating disorders are, due to the temperament predispositions that go with the condition, very often steeped in lots of formal education, they are used to the competitive grading structures that mean an absolute dichotomy of either being right or wrong.
I think this 2-minute video sums up precisely what your brain retraining experience should be with the right therapist or counsellor for you. Watch closely how the girl in this video reacts to failure, how she is coached and how she experiences success:
