CBT Technique: Binge Eating Example. Mental Contrasting + Implementation Intentions. (Willpower Tips, Day 17 of 21).
This is a technique I use with clients for diverse problems from binge eating to procrastination. I thought I’d provide a (fictional) example. The example is about binge eating.
The client is asked to write answers to the following questions.
Step 1. Most important wish that should be both challenging and feasible.
Let’s change that into an approach goal rather than an avoidance goal. What behavior are you going to do, rather than what are you not going to do?
Eat at scheduled times and not outside those times.
[Standard CBT treatment for binge eating is the client schedules when they're going to eat, not more than 3-4 hours apart, and commits to eating at these times rather than restricting, even if they've binged. It breaks the cycle of bingeing and restricting/skipping meals.]
Step 2: Most positive outcome of realizing your wish and events and experiences associated with this positive outcome.
Greater well being. I’m expecting to be a happier person. The experiences I think will be associated with it will be enjoying my life more.
Make a Daily Reminder Card & Review It Each Morning.
Write your answers to Step 1 and 2 on a card, and review it each morning. Or save it as a note on your phone and review it each morning.
Step 3. What’s the most critical obstacle to what you wrote for Step 1, together with events and experiences associated with this obstacle?
The most critical obstacle is having thoughts that if I eat as planned I will gain weight and feeling anxious when I have those thoughts.
Times when that might come up include:
After weighing myself each week [Weighing self weekly, not more, not less is part of standard binge eating CBT].
If I gain weight I might freak out. If I lose weight I might be tempted to restrict to lose more.
When anything triggers thoughts about it being a good idea to try to lose weight. Sometimes this happens after I’ve been to the gym and negatively compared my body to other people’s bodies. Also when other people at work are talking about losing weight or my sister talks about it.
After I’ve binged or after eating a treat food, it’ll be hard not to skip the next scheduled eating time.
Around my period, when my weight always goes up a little bit and my mood is a little bit lower.
Step 4. Forming Implementation Intentions Using the Following 3 Questions.
4A: When and where does the obstacle occur, and what can I do to overcome or circumvent the obstacle?
[Since we already answered the first part of this above, we will answer the 2nd part. The person will decide what they're going to do once the obstacle has already occurred.]
When I’m already having thoughts about wanting to restrict to lose weight, I can remind myself that I am stuck in a cycle of binge eating and restricting, that restricting puts me at risk of binge eating, and that overcoming binge eating is the most important problem to overcome right now. I can do this without self criticism, since self criticism depletes willpower.
When I’m ruminating that I will gain weight if I eat at regular times, I can remind myself that the average calories I consume when I binge is approx 1500-2000, a whole day’s calories. This has been the main contributor to gaining weight! I can remind myself that eating at regular times is likely to help me have a healthy weight, and that not eating at scheduled times is likely to led to bingeing and gaining weight.
I can acknowledge that worrying I am going to gain weight is a moment of suffering and I can speak to myself kindly rather than with criticism.
I can write some cards with those thoughts and my pre-prepared balanced responses. I can save my balanced, self compassionate responses in my phone as a note so that I can read them on my phone, since I almost always have my phone with me.
I can use the urge surfing mp3 to practice responding to thoughts and emotions without restricting my eating. [Restricting is a reactive behavior, just as much as binge eating itself. Although the mp3 is mainly for cravings, it works for any reactive behavior]
4B: When and where is an opportunity to prevent the obstacle from occurring, and what can I do to prevent it from occurring?
- I can plan some treat foods, so that I get used to eating treat foods occasionally, without it leading to binge eating or restricting. I can experiment with how many treats per week helps me feel least bingey.
- I can have mindful awareness of when I am only paying attention to the super skinny people at the gym.
- I can use techniques to not binge, since that is the thing that most strongly triggers the urge to restrict. Or, when I have thoughts that its ok to overeat a little bit because of a particular situation, I can remind myself of how this leads to the desire to restrict afterwards and that this increases my risk of bingeing.
- I can note my period on the weekly monitoring form I use to record my weight, number of binges and number of “good days,” so I can start to become more comfortable with the patterns of my weight going up around my period.
4C: When and where is a good opportunity for me to act in a goal-directed way, and what would the goal-directed action be?
When I am at the supermarket. I will buy some nuts so that I can eat these at planned snack times, even when I have the urge to skip the planned snack or restrict.
Each night when I run over whether my usual planned eating times will work with my schedule tomorrow or whether I need to make adjustments. I can make sure that I will have food I’m likely to want to eat available at my planned eating times.
When it comes time for me to do my weekly weighing. I can do it so I can get less scared of weight fluctuations and practice not overreacting to changes on the scale.
Step 5. Practice this technique.
Practice writing answers to all the questions each day (in preparation for the upcoming day). Pick a regular time to do this. Once you’ve practiced in written form enough times, you’ll start to be able to run through the questions mentally, and use the technique when unexpected triggers arise. Even when you’re good at this technique, returning to writing your answers some of the time is likely to help.
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