There were those of us — maybe me most of all — who did not believe it would be possible to incorporate backpacking into a residential eating disorder treatment program. Executive Director Diane Ryan, Admissions Director Carol Magee and me began talking about expanding Mirasol’s adventure therapy program to include backpacking in October, 2014. The challenges seemed overwhelming. First of all, since clients obviously don’t come to treatment outfitted for backpacking, we needed to purchase all the equipment from tents, sleeping bags and sleeping pads to flashlights, hiking poles and utensils. Over the next six months we patrolled eBay and Craigslist for good used equipment, and picked up additional items at sales. Friends got wind of the project and stepped forward with gear to loan or donate.
We took a leap of faith and purchased 10 wilderness permits in January. The timing was tricky, since we needed to make sure that any clients participating in the program were medically and emotionally stable and that they had arrived at a point in their treatment where a wilderness experience such as this could provide a significant boost to their recovery.
Of course the biggest challenge was the food. In retrospect, it’s hardly surprising that food would be an issue for an eating disorder treatment program. But I had not anticipated the difficulty of balancing the need to comply with each client’s carefully tailored meal plan with the need to maintain pack weight and bulk appropriate for a beginning backpacker. Our heartfelt thanks go out to Chef Dee O’Leary, who went way above and beyond the call to prepare hearty, backpack-friendly meals and snacks for our brave beginners!
The day before the hike was pandemonium, while we packed and repacked between checking the weather and trying to figure out how to transport staff and gear from three locations to a single departure point. We were nearly two hours behind schedule when we set out Thursday morning, but it was a gorgeous spring day with temperatures in the mid-70s and cloudless sky.
Over the next three days, we shared the magic of a sparkling stream that threads its way between walls of red conglomerate and yellow volcanic tuff in the Galiuro Mountains. There’s no real trail, so we wandered back and forth across the stream in the shade of giant Fremont cottonwoods and Arizona sycamores. We made camp on a sandy beach where there was a nice deep pool warm enough for a refreshing dip and with sun-baked rocks where we could stretch out like the many lizards we saw along the trail.
Evenings we shared our experiences from the day and stories of how we all came to be huddled around a crackling campfire deep in a canyon in the heart of southern Arizona.
I cannot say enough good things about the hard work and dedication of Executive Director Diane Ryan, Primary Therapist Katie Klein and Counseling Assistant PeiDong Zhang, who provided loving and tireless support to all the members of our group.
Only time will tell if this daring experiment produces lasting results. But the obvious delight of the clients who participated was an inspiration to us all.
As one of them remarked, “I always wanted to experience an outdoor adventure like this, but I didn’t think I could. Now I have the confidence to continue exploring my own.” May that confidence stay with you and sustain you and you move forward in your recovery!
Thanks for a memorable weekend, and a very big “wu gong*” to all of you!
*”Wu gong” became our favorite all-purpose expletive after PeiDong identified a large scary bug using his digital dictionary. For example, you might exclaim, “wu gong!” if a giant centipede was crawling down your back.
So often as clinicians we attend trainings which are solely focused on learning ways to help our clients. We leave armed with a plethora of new skills, but what about us, the helpers?
I have just returned from three days of training in The Trauma Resiliency Model (TRM), developed and adapted by Elaine Miller-Karas, LCSW. TRM is a useful set of skills not only for clients, but also for those who help them. TRM teaches skills to help adults and children cope with traumatic stress reactions, and it can be used by anyone as part of a wellness practice.
The goals of TRM are:
- To deepen the “Resilient Zone” so one is better able to adapt to the stressors of life with flexibility and decreased traumatic stress reactions.
- To provide self-care.
- To help reset the nervous system.
- To reprocess traumatic memories.
For both children and adults, traumatic and stressful experiences can produce a biological process of dysregulation that is self-perpetuating, even in the absence of ongoing external stressors or threats. Although insight about life experiences can be helpful, it doesn’t always bring the nervous system back into balance. Consequently, symptoms of nervous system dysregulation cannot be “talked away” but they can be “sensed away”.
Learning to stabilize the nervous system by managing sensations is at the heart of the TRM model. The nine skills of the Trauma Resiliency Model, outlined below, can be used singularly or in conjunction with one another. As Miller-Karas says, this is a forgiving model. If one of the skills doesn’t work, try another!
- Tracking: refers to the practitioner’s and client’s monitoring and reading sensations
- Resourcing and Resource Intensification: using positive or neutral factors to create non-traumatic sensations
- Grounding: being fully present in the moment
- Gesturing/Spontaneous Movement: bringing awareness to spontaneous gestures/movements that are self-soothing
- Help Now!: strategies to get back to the resilient zone
- Shift and Stay: shifting to a wellness skill and focusing on sensations of well-being
- Titration: graduated exposure to sensations of distress
- Pendulation: alternating between traumatic and resource sensations
- Completion of Survival Responses: Inviting the client to complete blocked responses
Working with Clients’ Trauma
When a client is pressed to remember a traumatic event, instead of resolving the experience, it may actually reinforce the fear and stress that are part of the recollection. Scientists have discovered the very act of remembering changes the structure of the memory. Similarly, when clients recount the narrative of their trauma, it can be re-traumatizing.
“It is an individual’s perception of an event as threatening coupled with helplessness that affects the nervous system.”
The beauty of TRM is that no narrative is needed; the body holds the story that words may be unable to express. A new narrative can emerge by processing through sensations in the body.
TRM uses an invitational model and language such as, “I invite you…” and “…or not”, always giving a client freedom and choices. We try to let the client be in charge of the session, since often power was taken away by the client’s trauma. TRM lets the client be the interpreter of his or her own experience.
A Model of Hope
Reflecting back on the TRM training, it became evident that this had not only been a practical, insightful workshop, but also a healing experience. Never before had I attended a professional workshop where there was such a sense of camaraderie, oneness, connection, and shared understanding. Thirty of us, all in the helping field in one way or another: a social worker aiding the homeless in Venice Beach, a clinician doing play therapy with children experiencing the effects of high-conflict divorces, therapists with private practices in the heart of Beverly Hills. One woman in particular stood out in particular, a documentary filmmaker who explores the connection of humans in different cultures. She came to the training to learn skills to help the residents of the impoverished countries she visits.
It was invigorating to share three days with these inspiring people, who were willing to be raw, vulnerable and open to doing their own work. Through our processing and learning of TRM together, we left instilled with the message that, “Adversity is not destiny.” The model tells us that there is only good news! We all have the ability to regulate ourselves and to track our own nervous systems. TRM de-pathologizes the human experience and shows us it is more biological and therefore more in our control, helping us recognize our own sensations of distress versus symptoms of well-being.
It’s all about going with the nervous system and not against it, as well as working with emotions in a different way.
“We do not have to be trapped by the storms of our bodies.”
All quotes and material taken from Elaine Miller-Karas, LCSW and The Trauma Resource Institute’s Trauma Resiliency Model Level 1 Manual (TRI, Claremont, CA, 2012).
“Honesty is reached through the doorway of grief and loss. Where we cannot go in our mind, our memory, or our body is where we cannot be straight with another, with the world, or with our self. The fear of loss, in one form or another, is the motivator behind all conscious and unconscious dishonesties: all of us are afraid of loss, in all its forms; all of us, at times, are haunted or overwhelmed by the possibility of this.”
(Whyte, D. 2015. Consolations. Many Rivers Press, Langley, Washington).
I attended an AA meeting last Sunday morning where the subject of the meeting was honesty. Interesting questions were posed such as:
- “What is honesty?”
- “Did you have a time in your life when honesty was completely disregarded?”
- “As your disease progressed, did it become more and more difficult to tell the truth?”
- “Did you even remember what the truth was?”
- “Did you cheat and steal to get drugs, alcohol, or food for your disease?”
- “Did people in your family lie?”
Lack of honesty certainly goes hand-in-hand with addiction to drugs or alcohol. Substance abusers lie to protect their drinking or drug behaviors, which become more important to them than their relationships with family and friends. The very same lack of honesty is present for most people with eating disorders. Many people lie about their eating habits. “I ate!” “I ate what was on my meal plan.” “I only ate a salad today. Why am I not losing weight?” They may lie when they talk about purging! Or binging. When someone begins to lie in one area of their life, it tends to spreads to many other areas.
When your life has been sustained by lies, it’s hard to open up and let other people see who you really are. But it’s only through living honestly than you can strengthen relationships, conquer problems, build self-esteem and create a richer and more meaningful life.
You may have already seen the ads for Vyvanse, the new FDA-approved drug for the treatment of binge eating disorder. Vyvanse was originally marketed for the treatment of ADHD, but Shire Pharmaceuticals, the drug’s manufacturer, is now promoting it as “an effective option to help curb episodes of binge eating.”
Binge eating disorder (BED) is the most widespread of all eating disorders and affects 1% to 5% of Americans. For years it was classified as a medical condition. But in 2013 the authors of DSM-V saw the light and classified BED as an eating disorder.
Psychological variables such as low self-esteem, depression and anxiety can trigger BED. Genetic predisposition, a close relative with an eating disorder or drug addiction or the metabolic disturbances caused from chronic dieting can also be contributing factors.
When people have BED, they frequently act impulsively. They feel ineffective and alienated and may be haunted by perfectionism. Individuals with BED are at higher risk of developing other illnesses, including anxiety disorder, cardiovascular symptoms, chronic fatigue, depression, infectious diseases and insomnia.
In today’s world of big pharma, it seems like there’s a pill for every illness. Clients who suffer from depression or anxiety seasoned with PTSD and substance abuse often arrive at Mirasol with a suitcase full of medications. But at Mirasol, we believe in “skills, not pills”. In 16 years of treating binge eating disorders and co-occurring conditions, we have found that a combination of cognitive behavioral therapy, dialectical behavioral therapy, nutrition counseling and alternative therapies such as EEG neurofeedback is far more effective than psychotropic medications.
Time will tell whether Vyvanse lives up to the manufacturer’s claims. It’s worth noting that in 2014, Shire paid more than $50 million to settle a claims that it had engaged in illegal marketing tactics, including marketing Vyvanse for unapproved, off-label uses and falsely representing its safety.
A recent article in the February 28, 2015, edition of the Arizona Daily Star calls much-needed attention to the high incidence of eating disorders among southern Arizona teens. Arizona ranks second in the United States for teens who have purged as a method of weight control and has twice the incidence than the U.S. average, according to a recent study by the U.S. Centers for Disease Control and Prevention.
However, I must take issue with two of the article’s conclusions. Firstly, the article attributes the prevalence of eating disorders to Tucson’s climate. It quotes Dr. Nia Sipp, medical director for Sierra Tucson’s eating disorders program, as saying, “Arizona has a lot of sunny, warm days and summer clothing is more revealing, which leads to more body image issues.”
Perhaps Dr. Sipp’s remarks were taken out of context. Although pressure to conform to cultural standards in body size complicates the challenges of acknowledging and recovering from eating disorders, body image alone is not responsible for their development. Eating disorders are a response to a complex set of factors, including genetic, neurobiological, social, developmental and relational. They are often associated with other mental health conditions, such as depression, anxiety, and substance use, and may be linked to bullying and childhood trauma.
Secondly, the article claims that it is very difficult to find treatment for eating disorders in Arizona. Again quoting Dr. Sipp, “Young people can’t find anyone to work with in the Tucson community,” she said. “You can throw a stone and hit an AA group, but there are really no free eating disorder support groups.”
Founded in 1991 and fully-accredited by Arizona Department of Health Services Office of Behavioral Health and the Commission on Accreditation of Rehabilitation Facilities (CARF), Mirasol Eating Disorder Recovery Centers offers residential and intensive outpatient treatment to both girls and boys ages 12 to 18, providing effective treatment to both adolescents and their families.
For teens, friends and family members concerned about eating disorders, the Mirasol website www.mirasol.net offers a wealth of information and an assessment that may shed light on symptoms and their severity. Additionally, Mirasol sponsors a weekly free community meeting for anyone who is struggling at our outpatient facility.
In light of compelling statistical trends, it is important to remember that eating disorders are the leading cause of death from any mental disorder, affecting males as well as females. Eating disorders contribute to serious medical complications across the life span. There is hope, however. Recovery is possible with ongoing support and high quality, evidence-based treatment.
Diane Ryan, MA, CPT
Executive Director, Mirasol Eating Disorder Recovery Centers
Eating Disorder Hope Award
- First Backpacking Trip with Mirasol Clients April 19, 2015
- Trauma Resiliency Model: A Portal to Healing April 13, 2015
- Honesty March 24, 2015
- Skills, Not Pills to Treat Binge Eating Disorder March 18, 2015
- Are Arizona teen eating disorders caused by climate? March 10, 2015
- Ground-Breaking New Research on the Genetic Origins of Anorexia Nervosa March 4, 2015
- Gone Wild: Backpacking with Mirasol March 2, 2015
- Curing the “Winter Blues” March 2, 2015
- TRE (Tension + Trauma Releasing Exercises) February 23, 2015
- Eating Six Times a Day? February 16, 2015
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