Applying Mindfulness Techniques to Eating Disorders: A Neurobiologic Perspective

Thursday, March 22, 2012: 10:45 AM-12:15 PM
Blue Topaz (The Charleston Marriott)
Mindfulness practice may reduce distress associated with eating in patients with EDs. Meditations focus eating with specific intention not to over-focus on palatability, hunger and fullness. The presenters will describe and demonstrate a framework for modifying strategies to target specific concerns. Eating, compassion, breathing, and emotion meditations will be described.
1. Navigating through the quarmine of "mindfulness" terminology

    A. Introduction

    B. Neurobiology: Levels of Mindfulness

         a. Physiological, Emotional, Cognitive, and Psychological

         b. Dieters, restrictors, overeaters, choatic eaters

         c. Mind, body, thoughts, and feelings

2. A Neurological Perspective

    A. Buddhism: The Eastern Concept: meditation

           a. Transcending consciousness

           b. Gamma waves (Stages II, III, IV sleep); changing the default mode

           c. Neurochemistry: Cortex, left PfC and right PfC; Synchrony

    B. Mindfulness: Psychotherapy

           a. Mindfulness Based Eating (MB-EAT)

           b. Dialectic Based Therapy (DBT)

           c. Acceptance Commitment Therapy (ACT)

           d. Awareness, Consciousness

           e. Alpha Waves; calming the amygdala

    C. Gentle Eating

           a. Relaxation

           b. Biochemical burdens of stress on digestion

           c. Cortisol: stew and chew

           d. Cephalic phase responses

     D. Slow Eating

           a. Chewing

           b. Sensory

           c. Portions

           d. Behaviors

     E. Mindless Eating

           a. Wansink: The bottomless soup bowel etc.

3. Relapse Prevention

4. Big Picture

        A. ED's as manifestation of disregulation and unmindful states

        B. What is healthy eating?

            a. Zone of indifference

            b. Mindful vs. intuitive eating

            c. How important is hunger?

            d. What is the difference between satisfaction and fullness?

            e. Role of desire

            f. Role of the cortex vs the bodies' cues

5. Focus in on eating

        A. Overwhelming challenges/out of control

        B. Mindset underlying binge eating

        C. Mindset underlying restriction

6. Review of systems for identifing treatment targets

        A. Food avoidance

        B. Social isolation

        C. Lack of meal structure

        D. Pacing issues 

        E. Binge eating

        F. Food rituals

        G. Dissociation

        H. Cravings

7. How to think about mindfulness as a tool to help change eating

        A. Mindfulness as a powerful self regulation tool

        B. Mindfulness to increase presence/attention

8. Demonstration of ways to incorporate mindfulness meditations to target eating concerns

        A.  Mindful eating

        B.  Compassion meditation

        C.  Breathing meditation

        D.  Emotion meditation


The food challenges facing those struggling with an eating disorder are often overwhelming and beyond their control.  Food avoidance, isolation, lack of meal structure, inappropriate pacing, vulnerability to binge eating and dissociation around meals are manifestations of poor self regulation and un-mindful states. Mindfulness practice may help reduce distress associated with working toward restoring normal eating by enhancing self acceptance and reducing the arousal state provided by negative thoughts and emotions.  Mindful eating meditations focus eating in a structured way, on purpose, without judgment with a specific intention not to “buying in to “ derailing thoughts associated with over-focusing on palatability, hunger, and fullness.  Healthy and appropriate eating is attained by overriding the dis-regulated “hungry brain” and retraining the body by committing to a structure of eating which will help them remain within the boundaries of hunger and satiety in the “zone of indifference”. 
Primary Presenter:
Kimberli McCallum, MD, CEDS, FAPA

A Board-certified psychiatrist in child, adolescent, and adult psychiatry, Kim is a fellow of the American Psychiatric Association, Associate Professor of Clinical Psychiatry at Washington University, and a CEDS. She is a psychotherapist with a range of therapy skills, including DBT, CBT, Maudsley, IFS, and psychoanalysis. She received her medical degree from Yale, completed training at UCLA Neuropsychiatric Institute, and Child/Adolescent Psychiatry Fellowship at Washington University. She is a member of AED and serves on the board of directors of NEDA and IAEDP. She has developed several eating disorder treatment programs including McCallum Place and Cedar Springs in Texas.

Ralph E. Carson, RD, PhD

Dr. Carson has been involved in the clinical treatment of obesity and eating disorders for over 30 years. His unique background in medicine (BS Duke University and B. H. S. Duke University Medical School) coupled with nutrition and exercise (BS Oakwood College, Ph.D. Auburn University) has prepared him to integrate biophysiological intervention with proven psychotherapeutic treatment. He consults with eating disorder programs and presents at conferences around the world. Dr. Carson is an IAEDP board member. He has recently published Harnessing the Healing Power of Fruit.

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