Eating with Wisdom:Eating with Wisdom:Cultivating Mindful EatingCultivating Mindful Eating

Jean L. Kristeller, Ph.D. Center for the Study of Health, Religion, and Spirituality

The Center for Mindful Eating

www.tcme.org Dept. Of Psychology, Indiana State University

j-kristeller@indstate.edu

Indiana State UniversityIndiana State UniversityBrendan Hallett, Psy.D. and Virgil Sheets, Ph.D.Brendan Hallett, Psy.D. and Virgil Sheets, Ph.D.Juli Buchanan, M.A., Brandy Dean, M.A., and Janis Leigh, B.A.Juli Buchanan, M.A., Brandy Dean, M.A., and Janis Leigh, B.A.

Duke UniversityDuke UniversityRuth Quillian-Wolever, Ph.D.Ruth Quillian-Wolever, Ph.D.

Sasha Loring, M.S.W., Jennifer Davis, M.S., and Jennifer Best, Ph.D. Sasha Loring, M.S.W., Jennifer Davis, M.S., and Jennifer Best, Ph.D.

Richard Surwit, Ph.D. and Richard Liebowitz, M.D.Richard Surwit, Ph.D. and Richard Liebowitz, M.D.

Acknowledgments

MINDFULNESS: a cognitive MINDFULNESS: a cognitive state, marked by attentional state, marked by attentional

stability, that disengages stability, that disengages habitual reactions and habitual reactions and

allows for inner wisdom to allows for inner wisdom to emerge.emerge.

Meditation:Meditation:Mechanisms and MisunderstandingsMechanisms and Misunderstandings

Meditation is NOT primarily a trance state.

Meditation is NOT primarily a relaxation tool.

Meditation is FUNDAMENTALLY a cognitive-attentional process that promotes self-regulation.

It has potential effects across MULTIPLE DOMAINS of psychological functioning: cognitive, physiological, emotional, behavioral, relation to self/others, and spiritual.

Usual Processing: Usual Processing: Conditioning Model & Eating ProblemsConditioning Model & Eating Problems

Usual Thoughts and Experiences

Conditioning ~~ Survival ~~ Attachment/Avoidance

Cognition/Attention

Physiology/Health

Emotions Self/Others

BehaviorSpiritual

XXXX

The Six Domain Model: Eating MindlesslyThe Six Domain Model: Eating Mindlessly

Cognitive: Preoccupation with food/eating; black and white thinking.

Physiological: 1) hyper-reactivity around food. 2) Disconnect from normal hunger and satiation cues.

Emotional: Depression; craving; anxiety.

Behavioral: Binge eating; highly conditioned responses to food; general overeating.

Relationship to Self/Others: Poor self-acceptance; self-hatred; anger at others; over-valuing thinness.

Spiritual: No wise eating; spirituality does not engage honoring body; value and meaning attached to food abundance.

Psychiatric Criteria for Binge Psychiatric Criteria for Binge Eating Disorder (DSM-IV)Eating Disorder (DSM-IV)

1. Recurrent binges, characterized by:

1. Eating, in a discrete period of time, much more than most people would eat.

2. A sense of lack of control during the episode.

2. At least two episodes of binge eating per week for six months.

3. Associated with eating more rapidly, eating until uncomfortably full, eating without being physically hungry &/or feeling very guilty or depressed afterwards.

4. Marked distress regarding binge eating.

3500 KCalories: 3500 KCalories: Overeating vs. BingeingOvereating vs. Bingeing

Overeating PatternOvereating PatternTime KCal7 am 2 eggs, bacon

2 slices toastOJ 450

10 am Doughnut 150

Noon WhopperMedium Fries 1130

6 pm 6 oz. SteakBaked potato2 vegies, rollApple pie 1320

10 pm 2 oz. Doritos1 beer 450

TOTAL 3500

Bingeing PatternBingeing Pattern

KcalCereal/milkOJ 260

Salad/diet dressingRollDiet Coke 300

3 oz steakBaked potato2 vegies 500

2 pieces Apple pie7 oz. Doritos1 pint ice cream 2440

TOTAL3500

MB-EAT:MB-EAT:Mindfulness-Based Eating Awareness TrainingMindfulness-Based Eating Awareness Training

Mindfulness meditation Eating experience meditations:

– Awareness of binge triggers

– Awareness of hunger

– Awareness of satiety (taste-specific, fullness)

Food-related meditations: raisin, chocolate, cheese/crackers, pot luck meal/buffet.

Mini-meditations with daily meals and snacks. Forgiveness and wisdom meditations Homework: meditation practice, mindful eating.

MB-EAT: Outline of SessionsMB-EAT: Outline of Sessions

1) Introduction to mindfulness meditation. Mindfully eating a raisin.

2) Introduction to “mini-meditation”. Mindfully eating cheese and crackers.

3) Binge trigger meditation. Mindfully eating sweet, high fat food.

4) Hunger Signals meditation (physical vs. emotional hunger).

5) Taste-Specific Satiation Signals meditation. Chips and cookies.

6) Stomach Fullness Satiety meditation. Pot luck meal. 7) Forgiveness meditation. 8) Wisdom meditation. 9) Have others noticed?; where do you go from here?

NIH TrialNIH Trial

NCCAM-funded randomized clinical trial with 3 groups: Meditation-based; Psycho-educational; Waiting List.

Two-site design (ISU and Duke).

9 week manualized intervention

1 and 4 month followups

More extensive measures including process measures and change in biological markers of self-regulation (lipid and metabolic profiles)

SampleSample

Sample size: N = 150 evaluated on all baseline measures; 14% men.

Approximately 14% African-American recruitment

Average age = 47.5; Avg. Wt. = 240 lbs.; Avg. BMI = 39.

Changes in Number of Binges in Changes in Number of Binges in Previous MonthPrevious Month

0

2

4

6

8

10

12

14

16

18

Base 1 Month 4 Months

# o

f B

ing

es

Control

PschoEd

MB-EAT

p<.01

(N =85)

Treatment Effects on Treatment Effects on Beck Depression ScaleBeck Depression Scale

0

5

10

15

20

25

Base 1 Month 4 Months

Bec

k D

epre

ssio

n S

cale

Control

PschoEd

MB-EAT

p<.001

(N =85)(N =85)

Treatment Effects on the Three Factor Treatment Effects on the Three Factor Questionnaire: DisinhibitionQuestionnaire: Disinhibition

8

9

10

11

12

13

14

15

Base 1 Month 4 Months

Dis

inh

ibit

ion

Control

PschoEd

MB-EAT

p<.001

MM vs. PE: p <.01

(N =85)(N =85)

Treatment Effects on the Three Factor Treatment Effects on the Three Factor Questionnaire: HungerQuestionnaire: Hunger

4

5

6

7

8

9

10

11

12

Base 1 Month 4 Months

Hu

ng

er Control

PschoEd

MB-EAT

p<.001

MM vs. PE: p <.10

(N =85)(N =85)

Treatment Effects on Treatment Effects on Lowe’s Power of Food ScaleLowe’s Power of Food Scale

40

50

60

70

80

90

100

110

Base 1 Month 4 Months

Po

wer

of

Fo

od

Sca

le

Control

PschoEd

MB-EAT

p<.001;MB vs. PE: p<.10

(N =85)

Treatment Effects Treatment Effects on Weighton Weight

210

220

230

240

250

260

Base 1 Month 4 Months

Wei

gh

t Control

PschoEd

MB-EAT

(N =85)(N =85)

Treatment Effects on Treatment Effects on Post-prandial GlucosePost-prandial Glucose

2.02

2.05

2.08

2.11

2.14

Baseline Post-Tx Follow-up

Po

st-

pra

nd

ial G

luco

se (

log

)

MB-EAT

PsychoEd

Wait-List

Relationship Between Practice Relationship Between Practice

and Improvement in Relation to Eatingand Improvement in Relation to Eating (n = 31-34)(n = 31-34)

Change in:

Type of Practice BESLess

DisinhibitionLess

Hunger Weight

General Mindfulness -.28 -.17 -.26 -.20

Eating Meditation -.26 -.34+ -.20 -.28

Mini-Meditations -.51** -.28 -.19 -.33+

Combined Index -.52** -.38* -.34+ -.41*

Results in Relation to the Multi-Domain ModelResults in Relation to the Multi-Domain Model

Cognitive: Disengagement from food preoccupation.

Physiological: Normalization of hunger and satiation cues; improvement in physiological/metabolic regulation.

Emotional: Decreased depression.

Behavioral: Decreased binging, interruption of highly conditioned responses.

Relationship to Self/Others: Improved self-acceptance; anecdotally, forgiveness of others.

Spiritual: Anecdotally, sense of connecting with the higher, wiser self; using meditation as prayer time.

Current NIH Study: MB-EAT IICurrent NIH Study: MB-EAT II Mindfulness Meditation: Mindfulness Meditation:

Regulating Eating and ObesityRegulating Eating and ObesityPI: Jean L. Kristeller, Ph.D., ISUPI: Jean L. Kristeller, Ph.D., ISU

NCCAM-funded randomized clinical trial with 2 groups: MB-EAT vs. Wait List Control.

Focus on obesity - moderately to morbidly obese (BMI>34).

12 week manualized intervention with increased focus on weight loss, plus 3 month support followup.

6 month total followup.

j-kristeller@indstate.eduj-kristeller@indstate.eduThe Center for Mindful EatingThe Center for Mindful Eating

www.TCME.orgwww.TCME.org