Anxiety underlies eating disorders, and eating disorders, in a sense, become a way to cope with the tension and rumbling nervousness. One way to treat eating disorders (EDs) is to focus on a person’s values and help them realize that eating disorders, while they might minimize anxiety temporarily, interfere with these values. (And, of course, are dangerous.)
Today, I’m pleased to present my interview with Emmett R. Bishop, Jr., MD, FAED, CEDS, medical director of adult services at the Eating Recovery Center, who discusses this technique, which at the Eating Recovery Center, they’ve termed values-based anxiety management.
Below, Dr. Bishop discusses how he helps patients with eating disorders discover their values and alleviate their anxiety. He also includes a tip for individuals who don’t suffer from EDs.
Q: What is values-based anxiety management, and how does it help people with eating disorders?
A: Values-based anxiety management is when we work with eating disorders patients to identify what they value in life and help them see how their values can trump their anxiety. We help them to understand that there’s something they value more in life than escaping their anxiety.
Eating disorders patients are incredibly anxious individuals. Being anxious is just part of their temperament; it’s one of their traits. They manage their anxiety with an eating disorder; be it anorexia, bulimia, binge eating disorder or eating disorder not otherwise specified (EDNOS). If you’re managing anxiety with an eating disorder, you’re keeping anxiety between you and what you value.
In treatment, we say we’re trying to change their “job description” from anxiety manager to values director. Patients strive to focus on their values versus escaping and avoiding anxiety through disordered eating behaviors.
Q: Why is it so important to focus on managing anxiety in eating disorders?
A: Eating disorders patients are very anxious in nature with high harm avoidance temperaments. They’d much rather find an escape route – such as eating disorders behaviors – than deal with their anxiety.
Because eating disorders are phobic disorders we have to “explode” the phobia and have patients confront their fears; something they’ve more than likely avoided forever.
In order to confront their fears, we must find something that overrides eating disorders patients’ anxiety and find something they value more than their eating disorder. It is helping patients manage traits that they cannot readily eliminate.
Q: How do you help patients figure out their values?
A: There are a number of instruments that have been developed by therapists in the Acceptance and Commitment Therapy field to help patients evaluate their values.
One we use here at Eating Recovery Center is the Valued Living Questionnaire by Kelly Wilson, PhD. This allows patients to identify what exactly they value in life and see how well they’ve done at living out those values. It’s a great tool for taking inventory of what you value.
[MT: Here’s a paper about the VLQ, which includes the questionnaire.]
Values flash cards, by Joanne Steinwachs, LCSW, are another therapy tool that helps people sort through their values. It’s really a brainstorming technique to come up with thoughts, feelings and items that patients might value.
Through these tools and by taking a values inventory, many patients may find they greatly value many things, but they haven’t been too successful at living out these values.
Q: Can you give us an example of how this technique has worked with a patient?
A: Values-based anxiety management works with those individuals that are ready to give up their eating disorder, but they don’t see a way out. Using values to manage one’s anxiety is especially important in eating disorders patients as they have low self-directedness. Once values are determined, patients have something to direct their life towards.
For example, if we don’t like a picture on the wall, we simply take it down. You can’t do that with the contents of the mind. The more you tell someone to not think about something, they more they will. But focusing on values really helps patients find a way out of their eating disorder.
One woman I worked with was continually delaying her wedding because she couldn’t imagine getting married while still struggling with her bulimia. I helped her question her actions and determine if they were helping with her values or not. I remember asking her, you’ve had this bulimia for 20 plus years, but do you value this relationship with your fiancé? If you value this relationship, then you can’t let the eating disorder stand in between. Once this young woman connected with her value of this relationship, she was able to move past the eating disorder and give up the bulimic behaviors.
Patients are always expressing their amazement once they find their values and are aware of the other things in life outside of their eating disorder. They can actually see those unwanted eating disorder thoughts fade into the background because they’re refocusing their lives around their values instead.
Q: How can this technique help anyone who’s stressed out?
A: Even people who aren’t struggling with an eating disorder can still find themselves in stressful situations. Often people struggle with thoughts or feelings that society views as negative. These things may not even directly affect you or your values, but because society considers it negative, you struggle with it.
Using values to manage that stress and anxiety can help people “get out” of the current struggle. It can help eliminate unnecessary struggles. Far too often we get caught up in what’s stressing us; when it may not even be something we value. Now, at times, things we do value do cause us stress, but knowing your values can help you redirect your energy and focus away from those situations, emotions or thoughts that stress you in life but don’t actually serve a value.
When those stressors come up, I recommend doing the following:
- Question the stressor. What value does this stressor or unwanted thought or feeling serve?
- Drop the rope. Get out of the tug-of-war, out of the struggle if what’s stressing you isn’t serving a value.
Q: Anything else you’d like readers to know about values-based anxiety management or eating disorders in general?
A: One of the most important think to know is that anxiety isn’t going to kill you. And, many times, it will go away if it doesn’t serve an important purpose. Anxiety is a protective emotion and is designed to get you out of trouble and avoid threats. You have to ask the question, does it serve a value?
Have you discovered your values? What are they? What has helped you manage anxiety?