Binge-Eating: What if it isn’t about Willpower - Part III
Note: In Part I of this series on Binge-Eating focused on ways to manage the urge to binge-eat by distinguishing between Appetite and Hunger. Part II talked about developing a game plan to avoid these situations all together by using Behavior Chains. In Part III we’ll pull all the pieces together from Part I and II by reviewing how behavior modification techniques can help using the example in Part II.
As mentioned in Part II, I’ve found the best way to head off a binge is by using Behavior Chains. This method asks you to trace all the steps (or links of a chain) that lead to a binge. Sometimes it will be just a couple of steps, other times there will be many steps and they will happen over weeks of time. Below, as promised, I’m going to use an example about myself to explain how to use behavior chains .
Let’s say I come home from the office and scarf down a bag of cookies (a binge for me). So, how did I get here? When did this binge start? When I ask this question in a group setting, usually each person has a different answer: “When my boss gave me a hard time”, “Bad traffic on the way home”, “Sick child”, on and on. But for me, and only for me, this binge started when I went down the grocery store cookie aisle two weeks before. As I mentioned in Part I, much of this is knowing yourself and sometimes this can take a long time. To identify the steps that got me to the place of binging on cookies, I need to start by re-tracing the events that created this moment. In this case, I ask, where did the bag of cookies come from? Were they on the kitchen counter or did I have to search a high cabinet shelf to find them? What size bag was available? Regular? Snack size? Am I feeling stressed from my drive home? Or maybe I’m hungry as I had a light lunch and no afternoon snack? As you can see, the questions can go on for a while. Know that each one holds a piece of the puzzle to stopping or managing binges or overeating in general.
There is some general information to consider when creating your behavior chains:
1. The event you are trying to avoid is called the terminal behavior, in this example it was binging on cookies.
2. The further away from the terminal behavior the better chance you have of changing the outcome because…
3. …Each step provides a little more energy to nudge you toward the terminal behavior. This is why trying to stop a binge at the final step usually doesn’t work. The situation has gathered too much momentum for you to “just say no”.
4. Each step on the path to the terminal behavior can provide alternative options that will either stop the chain of behaviors or slow it down or change the outcome.
Continuing with my example, here are the behaviors/steps that I’ve learned over the years that set the stage for a binge-for me:
1. Being hungry (usually I’ve missed a snack…lol…those of you who know me, know I seldom miss a meal)
2. Easily seeing cookies in my kitchen- Maybe I open a cabinet to get a glass and see a bag of cookies in the same cabinet.
3. Having a regular size bag of cookies instead of a snack size.
4. Bringing the cookies home from the store (or somewhere else, let’s say an office party).
5. Going down the cookie aisle. “How much can it hurt to have something sweet in the house?” or “It’s just a bag, I can handle it,” and other inner dialogue like this. “I will need these for company, maybe for lunch”.
As mentioned above, each step offers its own opportunity to change the outcome of the chain of behaviors (or steps) and the impact of the terminal behavior. And this is where classic behavior modification techniques (BMT) come in. Most of you know these things or have heard about them. For a quick review of BMT, see my handout here along with the H.A.L.T. list of other items that may impact options. Returning to the example above, but this time using the behavior modification information mentioned above, let’s start to create a different outcome for me with the cookies by changing the Behavior Chain. I’ve listed the above steps in reverse order as I’ve found it easier for brainstorming ideas.
Step 5 – If I really need to have cookies around the house, how about going to the store’s bakery (no need for the cookie aisle) and buying a smaller number of cookies? Or looking for a snack size bag of cookies, even if it is a container of several snack size bags. If you eat one bag you will have a couple of moments to think about reaching for more, unlike with a larger bag.
Step 4- if you find you are bringing home what are called “high-risk foods” (and these are different for each of us), consider ways to minimize their impact if you were to binge on them. Can you re-package them into smaller amounts? Store them in an area you seldom use or seldom see. Examples from my clients include, storing things in the garage, basement, even the trunk of the car.
Step 3-Similar to Step 4, how can you re-package things to slow down a binge. Buying snack size portions is one, another is dividing things up into smaller portions once you are home (and when you are not hungry!). Storing smaller amounts in containers you can’t see through.
Step 2 – See Step 3 and 4, above, for ideas.
Step 1- Decide if you are Hungry or if this is Appetite (see Notes below for definitions). If Hunger, do something positive about it, ie, eat. If Appetite, still do something positive to address it. See Binge Eating Part 1 (first section) for ideas.
Post Step 1 – if this chain involves food and you are giving yourself a hard time for eating: take a moment to write down what was eaten for the whole day including this episode, tuck this away for at least a day. Later, in a quiet moment when you are not hungry or distracted check out how many calories you ate. Subtract your metabolic calories and exercise calories for that day and see how many calories are left. My experience has shown two things. 1) Most clients are less than 500 calories over their goal…which leads to 2) they ate because they missed a meal and/or snack and had a large calorie deficit going into the high risk situation. (hunger strikes again!). Next, think about the easiest way to address these extra calories. This is no time for heroics. No drastically cutting back calories the next day as it is too risky that an extra low calorie day will cause another binge. Instead, consider adding an extra 100 calories of walking every day for the next few days. Something gentle that is easy to accomplish, that will dovetail into your already busy life, that will almost guarantee success. As I said at the beginning, if this sounds like a lot of work, that’s because it is. And this example assumes there were no surprises for me, imagine if a family member brought home cookies from an office party and left them on the kitchen counter.
Important note: There is seldom only one path to a terminal behavior. There are usually many. Some you’ll deal with every day and they will be easy to predict, others will only happen once a year (think holidays or a friend’s visit) and it might take a lot of imagination to remember the details to help set a different path. The good news is the “homework” required to change course can be done anywhere and over any length of time- maybe during the ads when you are watching a favorite TV show or listening to music. It can be helpful to start a chain and come back to it several times. Give this task some breathing room and allow extra time for more creativity in your response, more gentleness with yourself. Of course, the more you practice breaking down these chains and coming up with options to change course the better and quicker you will become at doing it real time when the unexpected happens.
Reflection –
As you may have already guessed, I’m going to suggest you try your hand at mapping out a couple of behavior chains using problem situations for you. Start with an easy one where you have the most control over the steps. Maybe your 3:00 pm run to the vending machine for something sweet. Then work up to a more complex scenario- maybe one that involves a visit to your family over a weekend or holiday (one where you may not have as much control over your environment). It can be helpful to talk with a trusted friend, counselor or dietitian about the chain of behaviors. There is something about saying the steps out loud that often helps to unhook us from some of the emotional aspects of confronting a path. Also, sometimes it is easier for others to help come up with ideas, especially in difficult situations. As mentioned above, give this task some breathing room and allow extra time for more creativity in your response, more gentleness with yourself.
What steps can you take beforehand to move these situations from high-risk to medium or even low risk?
What are ways to address not only tiredness but other strong feelings to better fit your goals?
Notes:
Hunger vs Appetite
For the sake of conversation, I define hunger as the physiological need to eat and appetite as the psychological longing for food; this is where stress and emotional eating live. So, how to tell the difference? Check out the first section of Binge-Eating Part I for details.