What they are, how they help, and ideas for goals to get the most out of them
Elevate Wellness is starting a new virtual meal process group to support those working on recovery from an eating disorder. This group will run Thursday evenings from 6- 7 PM beginning February 4th, 2021. I wanted to discuss what you can expect out of a meal process group, goals you can identify for the group, and what some of the benefits are.
Whether an individual is struggling with anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder, or avoidant and restrictive food intake disorder, meal times can present as a major challenge filled with anxiety and fear. Individuals will either avoid, have specialized rules around the food, only consume limited numbers of safe foods, or consume large quantities of food in a response to or as a way to manage this fear.
At all stages of recovery, exposure is an important aspect of the process. Exposure while in a safe environment, decreases fear and helps reduce avoidance. A meal process group can help provide a space where individuals can come and practice exposure to various fears around food and eating. This can lead to a better relationship with food and eating to further one’s recovery. The steps someone takes in group tend to generalize to other environments like eating with friends, family, or by oneself.
A group participant will choose a meal to have during group. The idea is to choose a meal where there is some aspect of it that is challenging (some ideas for different categories of goals are listed below.) During the meal, there is support offered by both peers and the clinician. Afterwards, time is spent to process emotions, successes, and struggles that occurred during the meal and identify potential goals to set between group sessions and for the next meal group. This can be a great adjunct to working with a therapist and dietitian in being able to challenge food fears with a group of people who are also working to recover from an eating disorder.
When identifying goals for a meal process group, it is important to look at various categories:
Food rituals
Fear foods
Trauma foods
Flexibility with eating
Social fears related to eating
Individuals with an eating disorder often engage in food rituals. Some of these rituals may be in an attempt to decrease anxiety around eating and others may be out of trying to decrease hunger. Rituals may look like eating small bites of food, eating extremely fast or slow, or chewing food a certain number of times. They can also involve eating food in a certain order or pattern. Goals to target these behaviors may look like challenging yourself to take typical sized bites of food or eating food in a different order.
Fear foods may have several different roots. As in the case of ARFID, a food may be fearful because of texture or a disgust response. With restrictive behaviors, feared foods may be viewed as more calorically dense foods or ones the individual has designated as “bad” for them. With binging behaviors, feared foods may stem from a belief that if they are eaten they will automatically lead to a binge. Making a fear food hierarchy can help identify foods that you are avoiding out of a disordered place and provide some structure in beginning to tackle these with exposure.
Trauma foods are often avoided because they are associated with a traumatic event. The difference between a fear food and a trauma food is the driving force of the fear. When the avoidance is associated with eating disorder symptomatology (fear of becoming fat, fear of binging, etc.) this is an eating disorder fear food. When the avoidance is driven by trying to escape trauma stimuli, this is a trauma food. When engaging in exposure with trauma foods, it is very important that you are working extremely closely with your outpatient therapist and dietitian to choose challenges that will allow you to stay within your window of tolerance.
Flexibility with eating is an important one. Even as rituals and fear foods decrease, there can be a clinging to eating at specific times, having set meals (always eating the same thing for a meal or snack), or not allowing for spur of the moment changes. Flexibility with eating comes into play when the grocery store was out of something you needed in order to make a certain meal, when you got home late and didn’t have time to cook the dinner you wanted, or you are going out with friends and are eating at a place and at the time the majority of the group wanted. Goals around flexibility can be more challenging because in planning to be flexible we take some of the spontaneity that is a part of itout of the equation. An example of a way to challenge this might be to have a friend or family member order or make a meal for you that you aren’t aware of ahead of time.
An often overlooked aspect of challenging fears surrounding meal times comes to the social aspect of eating. Most of the time, these fears are rooted in concern about judgment from others. “I’ll be the only one eating _____,” “Everyone thinks of me as the “healthy” eater, what will they think if the see me eating ______.” “I’ll be eating more than everyone.” Beginning to address and challenge these thoughts in a group of people with a similar goal of recovering from an eating disorder can ease being able to do this with friends and family.
There are many different goals that can be set to work on furthering your recovery and having a group to support you in this journey can make it feel more achievable. We hope you will join us for our virtual meal process group. If you are interested or have more questions please reach out to info@elevatewellnesstherapy.com.