Presentation on theme: "Meal Experientials for Eating Disorders: The Method to the Madness."— Presentation transcript:
Meal Experientials for Eating Disorders: The Method to the Madness
Objectives Identify and implement meal experientials with any client struggling with any type of eating disorder and help them break down barriers they perceive in a social meal setting. Use a protocol for experientials that include: pre/post meal goals; processing tools; and a list of creative ideas that challenge, yet support clients to manage “real world” meal settings through a systematic-approach. Effectively and respectfully monitor eating disorder behaviors that can interfere with an individual’s success in the experiential or in the group as a whole.
Exposure Therapy: The Experiential Ellyn Satter, MS, RD, LCSW, BCD – Eating Competence Model – “being positive, comfortable and flexible with eating as well as matter- of-fact and reliable about getting enough to eat of enjoyable and nourishing food.” Exposure Therapy- “the process of habituation, the natural neurologically-based tendency to get used to things to which you are exposed for a long time. “
What is Normal Eating? Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it -not just stop eating because you think you should.truly get enough of it Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good.
What is Normal Eating? (cont’d) Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful.mostly three meals a day Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings. Reference: Ellyn Satter, MS, RD, LCSW, BCD
Meal Experientials and levels of care Guidelines/ideas discussed could be implemented at any level InPatient – All meals/snacks provided by facility. Improved weight restoration with no choices. PHP – Increased exposure to meal planning, preparation, serving/eating group-prepared food and occasional restaurant outings
Meal Experientials and levels of care IOP – Emphasis on integrating into “real world” scenarios – Restaurant outings – Dessert outings – Catered meals – Nutrition education incorporated – Flexibility of meal plan and honoring appetite in any setting
Staff Responsibilities: Meal Experientials Be appropriately positive and enthusiastic Maintain dignity of individuals Use appropriate level of support needed by client Be a role model during meals – all foods fit (1/42) Provide and teach accurate nutrition, health and food information Honor “real” dislikes, allergies and dietary preferences (i.e.; vegetarian)
Why have meal experientials? Create “real world” scenarios to build confidence and gain success Encourage and enable client to eat with friends/family and limit social anxiety Practice ordering off a menu and making choices Learn “survival” skills during meal times – Engage in conversation – Use mindfulness techniques – Incorporate affirmations – Reach out for support if needed
Why have meal experientials? Practice listening to appetite Use substitution as needed Practice eating in a public setting and understand what the eating disorder makes up about this Encourage surrender to experience – Staff or peers might serve ct
Why have meal experientials? Practice meeting meal plan and body’s needs with a restaurant style meal Promote spontaneity and flexibility – relinquish control over food Creates opportunity to have a positive experience with a food that may have negative associations
“Rules” for experientials Minimal changes to item ordered only with approval Honor appetite and use containment of feelings/thoughts Water only and no refills – practice using voice Ct must use the restroom prior to meal and not again until break No entrée salads – sides permitted, no dressing on the side
“Rules” for experientials Use condiments appropriately and in reasonable amounts Dessert consumption – 50%-100% - listen to hunger/fullness and appetite (Ct may have individual goals) Use voice to ask questions about food items if needed EDBx’s monitored and handled with dignity
Meal Experiential Agenda 5p-530p – Introduction, review purpose and benefits of meal experiential; fill out goals sheet – goals sheets reviewed by dietitians 530p-630p – catered meal and dessert OR 530p-700p – dining out timeframe 700p-830p – after meal processing, nutrition lecture/activity if dining in, final group processing for support
Pre-meal goals (see handout) Hunger/fullness level and meal plan goals Struggles that may interfere with meal How does your ED want you to handle this struggle? How would your wise mind reframe it? Specific goals that will help you be successful Fears around the food or type of meal What tools can you use to cope more appropriately? What type of support would you like to have?
Types of Meals & Experiences Ethnic meals – offer wide variety – Mexican, English, Greek, American fast food, Italian, Chinese Themes – Holidays Examples: Thanksgiving, Christmas, Chanukah, 4 th of July, Valentine’s, St. Patrick’s Day, Easter – Themes Examples: Super Bowl party, opening day baseball season BBQ, carnival food, make a meal on appetizers, birthday party, summer picnic
Types of Meals & Experiences Incorporate finger foods and assembling foods – Wrap bar, taco bar, sandwich bar Dessert experiences – frost cookies, make a gingerbread house, ice cream sundae bar, chocolate taste test, small box of chocolates for Valentine’s Day, make dessert for a peer, identify jelly bean flavors – Iron Chef dessert competition
Types of Meals & Experiences Buffet style, serve self or others serve you Share a meal-requires using voice and negotiations Pizza, Chinese, calzones Seasonal foods – incorporate fall, summer, veg/fruits or other traditional foods Grocery store – plan, shop, prepare food
Potential Client Challenges Social anxiety – Set goals to address fears (i.e.; sit next to supportive person, engage in conversation) Fear of food or ingredients – Emphasize need for variety, body knows how to handle new choices, 1/42 x/wk, ED getting in the way of relationships, deprivation doesn’t work – Client may have individual dessert/meal goals Fear of not being able to meet meal plan or using substitution – Explain flexibility of meal plan when eating away from home
Potential Client Challenges Negative self talk – Use positive affirmations, stay engaged with group Emotionally full or hungry – Stick to meal plan as guide for what body needs – Use mindfulness exercises around taste, texture, temperatures and pacing Fear of not getting exchanges exactly right – Remind client goal is not perfection – Ask for support in figuring out meal plan – Encourage client to identify source of needing to be perfect
Potential Client Challenges Over use of condiments or fear of using extras like ketchup, jam, pickles, etc. – Remind client to normalize food based on typical ways condiments or extras may be used. – Reality check fears Anger/meltdowns – Sit next to for support, identify coping skills, partner for peer support, remove from situation to de-escalate, identify trigger for fear
Potential Client Challenges Refusal to participate – New admit vs longer term client Constant reminder to challenge ED in a safe, supportive environment and this is why you are here
Post-meal processing (see handout) Hunger/fullness coming out of meal Assessment of goals met Identify victories and level of control during meal ED or recovery focused and why? What might you do differently to make it more successful and/or meaningful next time? How did you use your voice during the meal?
Post-meal processing (see handout) Memories or associations with the food What kinds of feelings, thoughts or self-talk happened during the meal? Any rituals, urges or behaviors? What type of feedback and/or support were you given from peers/dietitian and how did it affect you?
Summary Goal is to push clients toward normal eating and take the power away from the food/experience through exposure therapy Be creative with meals and make “real world” scenarios Set client up for success with preparation for experience (pre-meal goals) Adequately debrief experience to highlight victories and improvements needed (post-meal processing)
Questions & Answers Feel free to contact Debbie at Debbie.Richardson@rosewoodranch.com
Reference List Satter, E. (1987). How to Get Your Kid to Eat: But Not Too Much. Kent, England: Bell Publishing Co. Eating Disorder Treatment in LA. (2012) Exposure Therapy in the treatment of Eating Disorders. Author : Lauren Muhlheim, Psy.D. Retrieved from: http://eatingdisordertherapyla.com/2012/03/27/exposure-in- the-treatment-of-eating-disorders/ Leacy, Kim A., Cane, Jessica N. “Effect of Non-Select Menus on Weight and Eating Concern in Adolescents Hospitalized With Anorexia Nervosa.” Eating Disorders 20 (2012): 159-167. Print.
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