Mindfulness for Eating Disorders, Overeating and ObesityDouglas Ziedonis, MD, MPH

Only 8 Research Studies, including different approaches to Mindful Eating (MBI, DBT, ACT, CEBT, CBMI, etc)

All non-randomized and without a control group

All relatively small sample sizes– Leahey et al., 2008 – Cognitive-Behavioral Mindfulness Intervention (CBMI); N=7– Proulx (2008)- Mindfulness-Based Intervention (MBI); N=6– Safer et al. (2007) – Dialectical Behavior Therapy (DBT); N=1– Corstorphine (2006) – Cognitive-Emotional-Behavioral Therapy (CEBT); N= 1– Baer et al. (2005) – Mindfulness-based Cognitive Therapy (MBCT); N=1– Heffner et al. (2002) – Acceptance and Commitment Therapy; N=1– Safer et al. (2001) – Dialectical Behavior Therapy (DBT); N=1– Kristeller et al. (1999) – Mindfulness-Based Intervention (MBI); N=18

Application of mindfulness-based treatments is becoming more common in clinical practice; however empirical evidence on efficacy is still needed

Assess for Addiction – What are the trigger foods / situations / behaviors

Understand the Craving (obsessions), Binging (compulsions), and Stinking Thinking

Denial, minimization, and rationalization– Physical Addiction – tolerance and withdrawal

What are the immediate Abstinence Goals? Food Plan / Monitoring

What are the long-term Recovery Goals?– Stage I, II, and III - personal responsibilities & plan– Fellowship and Support

Disease of Isolation– Alternative healthy highs & healthier choices

Check for Psychiatric Co-morbidities – Depression and Sweet Cravings

Public Health Orientation– Role of Marketing / Culture Change / Drug Dealers, etc

“The awareness that emerges through paying attention on purpose, in the present moment, and non-judgmentally to the unfolding of experience moment to moment”

– Jon Kabat-Zinn

1) Self-regulation of attention so that it is maintained on immediate experience, thereby allowing for increased recognition of mental events in the present moment.

– Body sensations, Feelings, & Thoughts2) Adopting a particular orientation toward

one’s experiences in the present moment, characterized by curiosity, openness, and acceptance.

– CompassionBishop 2004

Mind and health: Developing a neural marker for mindfulness, a pathway to health. (NCAM; PI: C. Fulwiler; Co-I: D. Ziedonis)– Using MRI to characterize changes in neural circuitry of emotion

regulation and relationship to recovery from obesity. Amygdala connectivity correlates with mindfulness (reduced

amygdala volume & increased hippocampus volume) Decreased Default Mode Network activity during meditation

Present moment vs Mindless Eating – Slow down - “Raisin

Exercise” – Attend to Body,

Emotions, Thoughts– Avoid self-judgment

Many Models: MBSR, MB-EATS, DBT, ACT, etc.

Linking with Spiritual Health

Jean Kristeller, Ph.D., Professor of Psychology, President/Co-Founder, The Center for Mindful Eating, Indiana State University

Kristeller & Wolever (2011) Eating Disorders

10-week courseUsed in the treatment of binge eating disorder, compulsive

eating, depression, weight loss, etc.Blends mindful eating exercises, CBT, MBSR, and general

mindfulness meditation practice“Mindful eating” exercises – e.g.,

Tune into body’s signals – become aware of physical hunger & notice fullness Chew slowly and savor your food Observe the sensory experience of taste Mindful food choices

Mindfulness meditation practice (general self-awareness, -acceptance, and –compassion; and emotional regulation)

8 week program (2.5 hrs / week) & 6 hour weekend retreatExplore mindfulness practice & discussion of topics related

to stress in daily life (50%)Living on automatic-pilotLearning to stopComing back to the breathRelationship of stress to illnessProblem focus and emotion focus copingAssertiveness in communications

Learn Formal & Informal Practices (50%)Homework

Formal Practices of Meditation & Gentle Yoga Exercises:– Ex: Awareness of Breathing, Sitting Meditation, Slow Walking Meditation,

Body-scan, Raisin Exercise (mindful eating), Gentle Yoga Exercises, Mountain/Lake Meditation, Loving-kindness Meditation, etc

• Informal Practice: many opportunities all day to enhance awareness:– Any moment – perhaps when you catch yourself being mindless and gently

redirect to the present moment– Consciously increase awareness to current thoughts, feelings, & body sensations

How the weather affects us physically– Pleasant experiences & unpleasant experiences– Reactivity to stressful situations or events– While communicating with others

Homework – Consider journal / log of your experiences.

Albers, S. (2008). Eating Mindfully: How to End Mindless Eating and Enjoy a Balanced Relationship with Food. New Harbinger Publications, Inc.

Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J. . . Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science & Practice, 11(3):230-241. doi:10.1093/clipsy.bph077

Chozen Bays, J. (2009). Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship With Food. Boston, MA: Shambhala Publications, Inc.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science & Practice 10(2): 144-156.

Kristeller, J. L., & Wolever, R. Q. (2011). Mindfulness-based eating awareness training for treating binge eating disorder: the conceptual foundation. Eat Disord, 19(1), 49-61. doi: 10.1080/10640266.2011.533605

Nhat Hanh, T. & Cheung, L. (2011) Savor: Mindful Eating, Mindful Life. Harper One.

Wanden-Berghe, R. G., Sanz-Valero, J., & Wanden-Berghe, C. (2011). The application of mindfulness to eating disorders treatment: a systematic review. Eating Disorders, 19, 1.