Distress Tolerance Skills to Stop Binge Eating
When you’re trying to stop overeating, every night can look like one of those cartoons with the angel on one shoulder and the devil on the other:
“Come on … it’s been a long day and you deserve a treat!”
“Now, be reasonable. You’re trying to fit into your dress for the reunion.”
“You already messed up the week by eating all those cookies last night. You may as well finish the box so that it isn’t there to tempt you.”
“Yes, but you know you don’t feel good when you overeat. Go for a walk!”
Sound familiar …?
Social media doesn’t exactly help matters. Right below an inspirational quote about loving yourself exactly as you are, you scroll past countless ads for fitness apparel saying something like, “If it was easy, everyone would do it.”
This can be very confusing. You’re wrong for not accepting yourself and you’re wrong for not working hard enough to improve. So how do we choose between #YOLO #SelfCare #DietStartsTomorrow, and on the other side, #NoExcuses #TransformationTuesday?
Have Your Cake and Eat It Too
There’s a research-backed approach for working with binge eating that actually says you don’t have to choose. I’ve used an approach called Dialectical Behavioral Therapy, or DBT, in sessions for years. Instead of throwing more rules and judgements at the conflict, DBT acknowledges being pulled in multiple directions.
Blending cognitive-behavioral techniques and Zen Buddhism, DBT helps you work within that tug-of-war experience itself before considering a specific decision. When you struggle with binging, this pause button can be the first step to digest (no pun intended) what’s going on under the surface.
Of course, looking under the surface can be hard! In fact, for all the turmoil that binge eating can create, it’s often there in the first place because it serves to numb an even deeper pain. DBT says that many people who struggle with overeating and binge eating (as well as other eating disorders and mental health issues) have a biological predisposition to intense emotions, combined with growing up in situations that invalidated these emotions. Turning to food actually works to decrease distress by allowing you to distract from it. So in that way, you’ve actually been very wise; in a situation where expressing difficult feelings wasn't ok, this coping skill worked at the source to soothe the original feeling.
Interrupting the Feedback Loop
But as you’ve probably noticed, binge eating and overeating don’t actually improve your emotions in the long-term. They distract you momentarily by creating a new discomfort to focus on: the feeling of fullness and the guilt and shame from getting stuck in this pattern yet again. This turns into a vicious cycle because the behavior that helps to deal with guilt and shame also causes more guilt and shame, creating a need for the behavior again, and so on.
This is where the acceptance piece can come in. If you’ve been trying and struggling to interrupt this cycle by stopping the binging behavior itself, maybe it’s worth jumping in at another point in the feedback loop-- targeting the shame that follows a binge. In fact, the reason I share this DBT perspective, and my own and clients' challenges with food and body image, is to help people stop judging and criticizing themselves. Overeating actually has very little to do with willpower or laziness or discipline or any of that! It’s a matter of genetics and temperament interacting with your environment.
My goal in therapy sessions and even in this post is to help you stop beating yourself up for something that’s not your fault. Even better, once you let go of the shame around overeating, you can learn and implement other skills to manage the emotions that you’ve been hesitant to face.
This week, I’d like to focus on the DBT skill of Distress Tolerance and share how it can help with binge eating.
What is Binge Eating and How Can Distress Tolerance Help?
Since binge eating is so often confused with poor willpower or self-control, I think it’s important to define what it really is. Symptoms of binge eating include:
Consuming large quantities of food in a short period of time
Feeling out of control and unable to stop
Eating when you’re full or not hungry
Frequently eating alone or in secret
Feeling depressed, disgusted, ashamed, guilty, or upset about your eating
Although many people overeat on Thanksgiving or Superbowl Sunday, binge eating is different. It likely serves the important purpose of numbing intense difficult feelings. So if we want to take this self-soothing technique away, it helps to have something to replace it with. Distress Tolerance skills are a way to deal with these emotions in the moment without making the situation worse.
This last part about not making the situation worse is actually very important. I often have clients who try a healthy coping skill with the best of intentions, but share their frustration that it didn’t work. I tell them that when a situation is outside what I call their "window of tolerance," sometimes it’s not actually realistic to expect any coping skill to fix the problem or even make us happy. The aim of Distress Tolerance skills like listening to calming music, singing along to loud music, or taking a hot shower is to get us back into our own personal window of tolerance. We’re not trying to be Gandhi. We’re just trying to survive the crisis.
Picture one of those Lamaze classes. The instructor would never even pretend that deep breathing will make the birth process easy. Instead, the aim is to teach self-soothing techniques in a supportive environment to help folks feel less alone and more equipped for the pain of labor and delivery.
Distress Tolerance skills are like your own personal Lamaze class; while they may not erase the discomfort of a stressful day at work, a tough breakup, or an especially loud inner critic, they help remind us that we have options.
Forming New Habits: A Hard Reset
So what are those options, you ask? Basically, Distress Tolerance skills fall into two categories: Acceptance and Crisis Survival.
Acceptance Skills
When I talk with clients about radical acceptance, one of the acceptance skills, the first thing we do is look at what acceptance is not. Acceptance doesn’t mean that you like something, or that you’re resigned for it to be true forever. It just means that you can let go of trying to change it for right now.
One example of radical acceptance is a client who wanted to include yoga in her recovery. She often noticed sadness and frustration in certain poses that caused her fleshier body parts to become uncomfortably squished. In these moments, she became so distressed that she wanted to leave the class. She compared herself to smaller women in class, and thoughts and images of her thinner days washed over her. She wanted to suck in her belly or adjust herself in other ways to look and feel more acceptable.
Acceptance doesn’t mean that we’re not allowed to want things to change. It means we acknowledge every step of the process and re-write the old story that we’ll be okay as soon as things are different. The story of acceptance sounds more like, “This feeling sucks, but I can be with it anyway.” As my client's recovery has progressed, she has learned to tolerate the distress of her negative emotions. She doesn't leave class, give in to urges to change her body. She less often turns to binge eating later as a way to distract from the distress. Instead, she practices observing her thoughts and emotions as nonjudgmentally as possible. She acknowledges that her body has changed over time, as bodies inevitably do. Her story now sounds more like, "This is the body I have in this moment, and it's good enough. I'm going to try my best to enjoy this experience today." It isn't easy to re-write these old stories. But you do get better with time and practice.
Crisis Survival Skills
But look, let’s be honest. Sometimes acceptance just won’t cut it. This is when Crisis Survival skills come into play. You might already be doing these without knowing it (yes, I see you belting out Carrie Underwood in the car after a hard day at work!) Music, aromatherapy, and anything that engages your senses helps to self-soothe and distract from the difficult feeling. I like to tell my clients it’s like pressing Control-Alt-Delete on your internal processing system when nothing else is working. Again, at this point, the priority is to survive the crisis without making things worse. This can also mean going for a walk or doing something with your hands like knitting. It could be making pro/con lists to tease out the conflict you’re facing.
Of course, it’s not easy to replace overeating with other Distress Tolerance skills, but don’t be discouraged. This is a practice! You may be un-learning decades of beliefs about yourself, and habits that may take time to change.
If you want to learn distress tolerance skills to decrease binging or overeating, I’d love to help! I have over 20 years of experience helping adults improve their mental health. I specialize in anxiety and eating disorders like binge eating, emotional eating and overeating, anorexia and bulimia. I offer in-person sessions at my Plano office and online therapy in Texas. Contact me for a free 15-minute phone consultation and take the first step toward recovery. If I can't help, I can connect you to another great therapist!
