Today I decided to review a book that I discovered a while ago, called "Brain Over Binge (Why I Was Bulimic, Why Conventional Therapy Didn't Work, And How I Recovered").
It is written by Kathryn Hansen, a recovered bulimic who developed her own approach to succumb binge eating after conventional therapy concepts (Cognitive Behavioural Therapy, Psychodynamic Therapy and Addiction Therapy) didn't work for her.
Basically, she sees the root of binge eating in an initial decision to diet, an not in traumatising experience and psychological issues, as traditionally seen in the majority of theories.
Therefore, binge eating illustrates a symptom of a survival instinct as a reaction to calorie restriction, and the more you engage in it, the more it starts to become a habit due to neural connections that are strengthened over time ("brain wiring").
She doesn't discount conventional treatment methods, claiming they are ineffective and useless, but she addresses the problem that while they helped her to stop irrational beliefs, thoughts and harmful behaviours of dieting, it didn't reduce her binges. Fruthermore, she emphasises that just because these concepts didn't work for her, and she believes they can definitely help other people. Her objective is mainly to help people who have made similar experiences like her and have given up hope in recovery.
I will briefly explain how the three conventional concepts aim to change the harmful eating behaviour, and why Hansen didn't find them effective for her:
1. Cognitive Behavioural Therapy:
The goal is to substitute the harmful behaviour (bingeing) with healthier alternatives or distractions in order to overcome the urge. For Hansen, this approach is only an indirect solution. While it helped her regarding confronting and reflecting on her binge urges, it didn't take away the desire to eat . If anything, it only fuelled this instinct, since it put even more focus and attention to it.
On top of that, CBT stays dependent on monitoring behaviours that recognise triggers on the long term, so in certain ways, you will always be something like a 'tamed pet' that isn't fully recovered.
2. Psychodynamic Therapy:
This form of therapy assumes that underlying psychological issues and past experiences (especially in childhood) are the root of problematic behaviours/thoughts/feelings. However, for Hansen realising that certain behaviours or statements her parents made in the past probably had an influence with the accumulating factors which eventually resulted in her decision to diet, but this insight didn't reduce her binge eating.
3. Addiction Therapy:
Proponents of this therapy believe that a complete recovery from excessive consumption of stimulating substances (including drugs, alcohol, cigarettes and food) is only possible by complete abstinence from the substance, which is obviously not possible for eating disorders, because food keeps us alive and we cannot avoid it altogether. This is why it is suggested to stay away from triggering foods that provoke a binge due to the hormonal and neurotransmitter responses, which are primarily refined sugar and white flour.
This means, you will always have to restrict yourself and will always have a problem with eating. And if you then do eat these foods (accidentally or lack of choice), this means you are relapsing, which may result in unnecessary negative thoughts that in turn could actually provoke a full on binge.
Hansen suggests an alternative approach that she has derived from the so called "Rational Recovery".
This approach has mainly been applied for OCD patients, who have similar thought and behaviour patterns like eating disordered people (intrusive thoughts, compulsiveness and black and white thinking).
It is assumed that our brain consists of two parts, the lower brain (or "animal brain") and the higher brain (prefrontal cortex).
The lower brain is responsible for all binge urges. It is primitive and includes our survival instincts, in this case the binge eating is a response to restrictive dieting.
The highest human brain, which is seen strictly separated from the lower brain, separates the "I "from binge urges by inhibiting them.
This can be achieched by the following steps:
1. view urges to binges as neurological junk from lower brain
2. separate highest human brain from urges (or as ego-dystonic)
3. stop reacting to my urges
4. stop acting on my urges
5. get excited (by realising that this works which will enforce future resistance to binge)
Taking this into consideration, developing binge eating as well as reducing it, is a form of conditioning and extinction.
The points are elaborated more precisely in the book. If you would like me to summarise them in a future Thrive Thursday post, just leave me a comment , and I am happy to do so.
My personal opinion on this book is overall positive.
I find this woman's story very inspiring, especially considering that she suffered from binge eating for her whole young adult life and had already given up hope until she stumbled onto this originally developed for OCD technique and applied it to a problem herself many people suffer from, which is very innovative.
While she cannot prove that this theory works by scientific evidence, I see parallels to a cognitive technique that I read about a few months ago, where binge urges or simply urges to eat unhealthy foods, are seen as intrusive passengers on a bus, that you are blocking out, which is equivalent to a ego-dystonic technique (other passengers are not part of you).
I definitely don't think that it can replace conventional therapy, because it is important to address underlying issues and irrational beliefs or harmful thoughts, however it is worth considering implementing it in cognitive techniques as a method to help reducing binge eating urges that will in turn make it easier to develop better alternative behaviours.
The only negative point I would like to mention is that Hansen sees certain disease criteria, e.g. "compensatory behaviours such as the use of laxative and overexercising" as "no sign of disease" which I disagree about, because from personal observation a person without an eating disorder would keep eating normally after overeating.
Find out more about the book here. I definitely recommend it to people who have a long history of binge eating or other eating disorders. I also think that it is very important to read for people who are thinking out going on a strict diet, or are already on it. The sooner you prevent potential harmful consequences, the better; especially considering that Hansen sees her initial root for problematic eating (first anorexia, then bulimia) in her decision to diet.