Practicalities - anzaed.org.au
Transcript of Practicalities - anzaed.org.au
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Beyond Body Image: The Body as a Resource in ED Recovery
Presenters:Janet Lowndes; MAPS, RYT
Director; Mind Body Well
Fiona Sutherland, APD, RYT
Director; The Mindful Dietitian
Practicalities
• Please use Q&A box for anything you'd like Fiona and Janet to see. We will not be viewing the CHAT box
• Due to the large number of participants, your microphones will be muted during the presentation and question periods, all questions will be via the Q&A
• You’re welcome to have your video on or off, the choice is yours
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Introduction and Foundations
Our focus today
1. Introduction
2. Body Image
3. Intrapersonal - Embodiment
4. Interpersonal - Collective
5. Practice and Growth
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Our invitation to you…
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Reflective qns
• Do you live in a body that experiences pleasure, pain, agitation, excitement, sadness…
• Do you work with other who experience pleasure, pain, agitation, excitement, sadness…
Assumptions we are bringing:
All humans have an intrinsic need to feel safe
We develop coping strategies in an attempt to feel safe in our bodies (for
some people, this is experienced as ED symptomatology)
The way forward is not just about reducing
symptomatology, but involves returning to our
bodies in adaptive, healthy ways
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“To effectively prevent and treat eating
disorders those at risk and struggling must
learn how to navigate life without leaving
themselves or turning against their bodies”
Cook-Cottone, 2016, p.105
The work we do within ourselves (within us, clients within themselves)
The work we do which intersects with our clients work
The work which resides in our culture.Common humanity, shared experiences
Intra-personal
CollectiveInter-
personal
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Body Image
History and definition of BI
“The image of the human body means the picture of our own body which we form in our mind, that is to say, the way it appears to ourselves” (Schilder, 1935)
“internal representation of your own outer appearance” (Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999
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How is the body conceptualized (if at all) in our current evidence based approaches for EDs?
Building on best practice in EDs
EDs are inextricably entwined within the context of culture and how the body and the notion of embodiment are held
within culture, as are approaches to ED treatment
(Gordon, 2017)
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Why move from traditional “treatments” to embodied approaches?
▪ Treatments for ED have improved with a growing empirical base indicating, at best, moderate efficacy (Linardon & Wade, 2018; Zeek et al., 2018)
▪ Findings reinforce the contention that interventions have yet to address the full scope of variables driving ED behaviour (Dilberto& Hirsch, 2019)
▪ Treatment recommendations appear to support decreasing ED symptomatology and key mechanisms underlying core symptoms with only moderate success, at best.
From managing symptoms to embodying a positive relation to
oneself.
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Positive Embodiment
3
Mechanisms, underlying symptoms 2
ED Symptoms1
3
2
1
Positive Embodiment
3
Mechanisms, underlying symptoms 2
ED Symptoms1
3
2
1
Abnormal, disordered
Targets for reduction
or eradication via
cognitive &
behavioural tools
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Positive Embodiment
3
Mechanisms, underlying symptoms 2
ED Symptoms1
3
2
1
Body as valuable
resource, safety seeking
Use cognitive &
behavioural tools
PLUS
opportunities to practice
skills & develop increased
capacity for positive
embodiment
The Embodied Self (Cook-Cottone)
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Intrapersonal -Embodiment
Embodiment
“The lived experience of engagement of the body in the world”. (Philosopher Merleau-Ponty, 1962)
“Mind and body are inseparable, and the body
is not only the centre of perception, but also of
subjectivity: experiencing the world
meaningfully”. (Piran (2017), p.2).
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Embodiment
“A way of being (non-dualistic conceptualisation self) in which being is
understood as residing in and manifesting from the body as one
experiences the:
- internal (ie. physiological, emotional, cognitive)
- external (ie. interpersonal, social, cultural), and
- existential dimensions of life”.
Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.1
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Dimensions of the Experience of Embodiment
NEGATIVE POSITIVE
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REFLECTION
INTERRUPT ENHANCE
What experiences might interrupt V'S enhance, healthy embodiment?
Positive Embodiment - EXAMPLES
INTERRUPT ENHANCE
Trauma / abuseShameDietingMisassigned gender at birth / MisgenderingIllness / injury / pain / disability / medicationsEarly needs not adequately metDisruption to early feeding Learned mistrustStigma / oppression / marginalizationRacismFood insecurityUnhelpful role modellingLearned body dissatisfactionFertility issues and treatmentsStigmatising medical careetc...
Secure attachmentEarly ‘successful’ feeding Early needs adequately metRegular embodied practicesHelpful, positive role modelling Support to navigate natural body-related experiences eg.Puberty, pregnancyOpportunities to enjoy the body / be playfulCulture and community of acceptance – diversityGender identity acknowledged and honouredMedical care accessible and stigma-freeBeing safe to resist objectificationetc...
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Moving from body as OBJECTto body as RESOURCE
Requires:
1. Listening, experiencing and knowing
2. Trusting and responding
3. Inhabiting and celebrating
1. Listening, experiencing and knowing
INTEROCEPTION - “The process by which the nervous system senses, interprets, and integrates signals originating from within the body, providing a moment-by-moment mapping of the body’s internal landscape across conscious and unconscious levels”.
Khalsa et.al. (2017) ‘Interoception and Mental Health: An Overview’. Biological Psychiatry
NEUROCEPTION - “Neuroception represents a neural process that enables humans and other mammals to engage in social behaviors by distinguishing safe from dangerous contexts. Neuroception is proposed as a plausible mechanism mediating both the expression and the disruption of positive social behavior, emotion regulation, and visceral homeostasis.”
Porges (2008) ‘The polyvagal theory: New insights into adaptive reactions of the autonomic nervous system’.
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2. Trusting and responding
What’s required in order to trust and respond to my body?
WILLINGNESS - am I prepared to give my body what it needs?
RESOURCES - do I have access to the necessary resources to adequately respond to my body?
COURAGE / SAFETY - Is it safe for me to give my body what it needs?
SUPPORT / COMMUNITY - am I well supported to take these steps?
3. Inhabiting and celebrating
What does it mean for you, and for people you know to inhabit and celebrate their bodies?
• Safety
• Connection
• Freedom
• Liberation
Explore the personal meaning of this
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Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.31
Practice Tip
Actively bring the body into the therapeutic conversation.
Listen out for any experiences your clients share which reflect connection and/or disconnection from their bodies?
• Slow down
• Connect - self and other
• Affirm
• Validate
• Stay with
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Interpersonal & Collective
Intra-personal
CollectiveInter-
personalWhat supports people
to feel safer in their bodies in their work
with us?
What supports people to feel safer in their bodies in the world
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What does this image represent to you in terms of embodiment and the space we share with others?
The Inter-personal space
How do you think the therapists own embodiment impacts on the relational space between therapist and client?
What could the impact be of this relational space on a clients experience of and in their body?
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Therapeutic stance of embodied approaches
Doing toBeing with
What might happen when we feel “stuck” with someone’s body-related experiences?
1. Intellectualise – “fixing”
2. Rationalise – “this is normal for humans”
3. Avoid / distract / deflect – “let’s talk about something else” or “it’s not about your body”
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Our own experiences of embodiment
Positive Embodiment
INTERRUPT ENHANCE
Trauma, abuse, neglectDieting, inconsistent dietary intakeMisassigned gender at birthIllness / injury / pain / disabilityEarly emotional or physical needs not adequately metDisruption to early feeding relationshipLearned mistrustStigma / oppression / marginalizationRacismFood insecurityShameUnhelpful role modellingLearned body dissatisfactionMedications Fertility issues and treatmentsMisgenderingStigmatising medical care
Secure attachmentEarly ‘successful’ feeding Early needs adequately metRegular embodied practicesHelpful, positive role modelling Support to navigate natural body-related experiences eg.Puberty, pregnancyOpportunities to enjoy the body / be playfulCulture and community of acceptance – diversityGender identity acknowledged and honouredMedical care accessible and stigma-free
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Working with our own body AND the body of others
What the conditions we can provide to enhance safety and embodied experiences?
• Resonance (“I see you”)
• Expectancy (boundaries, integrity of practice)
• Co-regulation (ability to stay in safe and social, ventral vagal state)
• “Creating a welcoming environment” (Deb Dana, 2018) = “I feel safe here”
For more on this see the work of Porges, Dana, Fisher
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What are possible signals of safe/unsafe?
Consider – office space, language, recommending reading/podcast, website, interventions/treatment modalities
The collective work =
How can we ALL contribute towards communities and the world being a safer place for people in all bodies?
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Contributing to a more inclusive community
• Reflecting – with deep honesty – on our own beliefs about bodies
• Understanding how bias, stigma and discrimination show up in our research, community and treatment settings
• Being willing to partake in uncomfortable conversations and actively challenge myths about EDs which are based in bias eg. people in larger bodies with an ED must have BED
• Undertaking trainings in working with diverse groups and actively engaging in supervision
UnconsciousConscious
UnexaminedConscious Examined
ACTION
- Exposure to learning- Support / supervision
- Willingness - Exposure to learning- Support / supervision- Opportunity- Community- Courage - Tenacity
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Ways to expand our learning and advocacy
Exposure and engagement with those with lived experience• Fat positive• Disability• LGBTQI+• Age diversity
Advocating for more expansive and bold researchSpeaking up about stigma in research, interventions and treatment settings (even if it’s old but still well recognised)
Practice and Growth
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What sorts of practices may assist a client develop embodied awareness?
Please briefly type some of your ideas into the chat box…
Embodied Awareness and Self-Care
The language of self-care can be a valuable way to direct our clients toward embodied practices.
Self-care is already:
- recognised
- understood
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Mindful Self-Care Process
”The daily process of being aware of and attending to our basic physiological and emotional needs, including the shaping of our daily routine, relationships, and environment as needed to promote self-care”. Cook-Cottone (2020), p104
Requires:
1. mindful awareness of self-care as essential to wellbeing2. assessment of self-care domains3. assessment-driven self-care goal setting4. engagement in self-care behaviours
Cook-Cottone (2020), p.116
Mindful Self-Care Scale
1. Nutrition and hydration2. Exercise3. Rest4. Physical and medical care5. Self-soothing6. Self-compassion7. Relationships8. Environmental factors9. Spiritual practice10. Self-awareness and mindfulness
INTERNAL aspects of self
EXTERNAL experience of self
CENTRE of the self
Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.106
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What's YOUR personal Self-Care Plan?
1. Nutrition and hydration2. Exercise3. Rest4. Physical and medical care5. Self-soothing6. Self-compassion7. Relationships8. Environmental factors9. Spiritual practice10. Self-awareness and mindfulness
INTERNAL aspects of self
EXTERNAL experience of self
CENTRE of the self
Cook-Cottone, C. (2020). Embodiment and the Treatment of Eating Disorders. p.106
Thankyou!