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June 7, 2018

Building Community in Recovery

A Conversation with Clinicians from Mirasol Recovery Centers

Our former clients report that their biggest challenge is recovery isn't relationships or body image — it's loneliness and isolation. Loneliness, it turns out, is a bigger health risk than obesity or smoking. So how do we help clients build the supportive communities they need in recovery? Is social media part of the solution? Or is part of the problem? We asked Mirasol clinicians to weight in:

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Marion: "How this all got started is when I was doing the alumni survey, we asked people what were the issues they were struggling most with in recovery, and we thought they'd say 'body image', 'family relationships,' 'school', whatever. But instead one was 'loneliness' and number three was 'isolation'.' So after that Diane and I started doing more research and it turns out there's all kind of research on the health effects of loneliness. It's actually considered to be more dangerous to your health than smoking. So we did a panel discussion a few months back, and that was well received. We're doing some more research now on the relationship between physical fitness apps and how they interrelate with eating disorders. And that got us talking about 'Is the use of social media a factor not only for eating disorders but does it also make recovery more complicated because people don't know how to build the communities that they will need?' Does social media actually help you connect with other people?"

Diane: "So there are two things here: 'How does social media impact loneliness and social connection and our ability to be in relationships with one another', and "Is there something special about people with eating disorders and recovery that makes it even more challenging?' So it might be something that's valuable for people in the general population but maybe not so valuable for our clients when they leave treatment?"

Rachel: "Whenever you're around other people, that person amplifies wherever you're at. So I think it can go to a bad place very quickly."

Marion: "There's Facebook's tendency that we know about to try to show you things that it thinks you're interested in, so if you've been looking at a lot of pro-ana, pro-mia sites, you're probably going to see more of those kind of messages. It's the 'echo chamber' effect of social media."

Diane: "And the research does show that people with eating disorders' behavior increases in severity in proportion to their use of social media."

Marion: "So that begs the question, 'Are they more susceptible to the ill effects of social media?' Is there a relationship there, and if so, what's that coming from?"

Carol: "We all have a tendency to connect with people who have the same interests and the same perceptions that we have, so if someone has a full-blown eating disorder, they will try to connect with people like themselves to get validation for their particular disorder and for their behaviors."

Katie: "Eating disorders are so isolating. People who have eating disorders are not likely to go out in the world and try to form a connection because their primary connection is their eating disorder. So they're more likely to go online, and they're probably not looking for recovery-focused websites. So I think it can be really dangerous."

Don: "I think it's also telling that many of our clients, after they enter treatment, choose to delete or hide their social media accounts. For various reasons, but I think a lot of it has to do with the connections they were making that they realized were unhealthy."

Marion: "So is that something we should suggest to clients? What do you think?"

Jaynie:"Eating disorders — at least the way we approach them — is that we want to find the middle ground — the gray areas — and I think that is so hard with social media because it's all about the aesthetics. 'What am I putting out there? What do I want people to see?' And that's what social media is. We are totally controlling what people are seeing of our social selves. Almost no one is authentic on social media. If all you're seeing on your Instagram feed is people exercising and eating a 'healthy' diet, that's even more isolating for someone who's trying to be in recovery and trying to challenge those behaviors and those beliefs."

Sharon: "Early on in their recovery, they're often having to recreate their entire social circle because they may realize the people they've been spending time with aren't healthy connections. A person might then see people that they used to be friends with hanging out, doing stuff, interacting and feel very left out and very lonely because they're no longer a part of that.

Tammie: "Recovery on its own can be a lonely experience because I think we live in an addictive world. So recovery in and of itself makes you different. And the strength that you have to have to carry out recovery in an addictive community is hard. One thing that's great about social media is that it's a way to take baby steps in communication. It allows us to create a space where we're really thinking about what we're saying in writing it. Sometimes we'll have a conversation via text that we wouldn't have in person because it's more comfortable and we do have kind of a barrier. But then when we go on social media — like Facebook — people often are not emotionally responsible and we get these reactions where people aren't considering the impacts of their words. And if we're not strong enough in our recovery, that becomes very difficult to hold."

Marion: "It sounds like it's really a two-edged sword. It can be really positive and it can also be super dangerous. What kinds of tools can we give clients so that they are equipped to handle social media in a responsible way but also build more face time — real face time — connections with other people?"

Diane: "One of the things that seems to be effective in combating all of this is creating traditions and rituals, which is something now our culture is lacking since we've moved away from religion as a society. We try to foster that while they're here. We do a potluck every week when they get to the partial hospitalization level. There's an important reason to have that collective social experience, particularly around food. We do morning practices as a group, as a way to just come together in the morning and set an intention, to say "where I'm at' and 'what do I want my day to be like'. So just to try to foster those kinds of habits and maybe creating fertile ground for them to continue those kinds of things as they move out in the world, although it's really challenging as they move out into the world because so many of our clients have social anxiety. And the other thing that happens neurogically when you experience loneliness mirrors what happens when people have trauma. Since almost all our clients have some type of complex trauma, the social anxiety feeds into 'fight or flight' responses."

Katie: "We do a lot of group therapy, and we find that group therapy is one of the most effective modalities for recovering from an eating disorder because it fosters connection — being vulnerable, being authentic — and seeing that other people have shared experiences. It's a nice cocoon within treatment to really practice being open and honest and recognizing that other people are going to accept them, and then being able to walk out of Mirasol and recreate that in relationships outside of treatment."

Marion: "Do people know how to make friends? I mean, in general, do we know how to make friends?"

Susan: "I actually do a 'Friends 101' with some of my clients. How to ask people to hang out with them and talking with them about what it is to be a friend, and identifying their own beliefs and values around friendship and how that can add value to their lives."

Jaynie: "So many of our clients are emotionally stuck at a much younger age. So when you're high school or grade school age, friendship looks very different than it does as an adult. And I think it's really hard for them to wrap their minds around the fact that friendship is just about being without someone. And we think that social media is going to give us the same satisfaction that just being in someone's else's presence does. And it doesn't. We're not going to feel as happy when we're talking to someone on social media versus when we're just sitting next to another human being. And that's what I think adult friendship is all about. It's just relating to someone and holding space with someone. And that's uncomfortable for people with eating disorders when they don't really know who they are and don't know how to hold that space and are still learning that process."

Sharon: "DBT also deals directly with this issue. One of the modules is 'interpersonal effectiveness,' and several of the specific skills that clients learn while they're at Mirasol are related to forming friendships. Learning how to talk to people, how to be mindful of other people when communicating and interacting. And then there are specific skills for looking at your current relationships. Are they harmful or are they healthy? A lot of the clients who have been very isolated have found these skills to be very helpful to them."

Diane: "I think it's a very sensitive area, because so many of our clients, when they engage in relationship, they tend to attract the same kind of people they've been involved in their lives who created the trauma. So there's a constant risk of retraumatization. So it's an even higher bar. So 'how do I know when a person is safe?' 'how do I set appropriate boundaries?' It's really easy to say that the solution to attachment trauma is connection. How are we going to foster that in our clients while they're in treatment and how are we going to help them going forward? I think it's probably something we need to pay more attention to in terms of setting people up for success."

Jaynie: "Social media is a popularity contest. It would be so much different if all it was just posting things. But I don't think there's any social media out there that doesn't have some sort of upvoting system. And that's so dangerous for someone who is so focused on what they're putting out in the world. It's hard to have the courage to be your authentic self."

Diane: "For adolescents, the research shows that the predominant feeling that teens get having surfed on social media is 'other people are doing things and I'm being left out and my life is not nearly as interesting as everybody else's."

Rachel: "People share things that you wouldn't share, even if you were sitting right next to them. So it's a false sense of closeness. And it feels like a boundary thing, where it's acceptable to tell everybody everything, so it's kind of like fake vulnerability. You're not really faced with them and feeling what it's like to share this information."

Diane: "It's a substitute for connection. If you're on social media and you feel like you're connected, you're not really connected. And it can actually prevent you from seeking out those face-to-face connections, which is where the real juice is."

Rachel: "At our residential level, we ask clients to get away from all of the medicators — specifically all social media — so they get an opportunity to see what their life is without all of these things on their phones. And then they step down to the PHP level of care and they're able to explore 'how is this impacting my day-to-day life?' I think there's a lot of room in Mirasol to explore this territory."

Marion: "Do we ever do groups on the safe use of social media?"

Jaynie: "I did a group once where, on my own time, I googled 'fitness tips'. And I wrote down some statements that weren't super obvious but that still sent messages that I thought could be really dangerous for the clients if they were to stumble upon them in doing their own research. So I did a group and had them process what was coming up. And so many of them said, 'Yeah, I would have seen these statements and not thought too much of it at first, but now I'm seeing that they're sending a really dangerous message. There's so much information out there and oftentimes you can't control whether it gets to you or not. So teaching them how to critically think about the messages that they see and hear, I think is a really important part of their education."

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