Intuitive Eating & Attunement By Tribole

Intuitive Eating & Eating Disorders: Attunement of Mind & Body Evelyn Tribole, MS, RD Co­author Intuitive Eating August 7, 2009

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Objectives  When & how to Implement  Overcoming Barriers  Identifying Readiness  New Intuitive Eating research  Attunement 

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Attunement Internal

External

http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp 

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Mis­Attunement Internal •Unfilled Appetites •Eating Struggles •External­Based http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp

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External Over­valued Extreme Makeover

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Disconnect  Problem

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     “Interoception 

is the    

perception of sensations from inside the body  and includes the perception of physical  sensations related to internal organ function,  such as heart beat, respiration, satiety, and  autonomic nervous system activity related to  emotions. 

”

Mehling WE et al. 2009 Body Awareness: Construct and Self-Report Measures. PLoS ONE 4(5): e5614. doi:10.1371/journal.pone.0005614

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Walter H. Kaye et al . New insights into symptoms and neurocircuit function of anorexia nervosa Nature Reviews Neuroscience. published online 15 July 2009; doi:10.1038/nrn2682. 

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Walter H. Kaye et al . New insights into symptoms and neurocircuit function of anorexia nervosa. Nature Reviews Neuroscience. published online 15 July 2009; doi:10.1038/nrn2682. 

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 What the Research Shows  Intuitive Eating Scale: l Unconditional Permission to Eat l Eating for Physical Not Emotional l Reliance on Internal Hunger/Satiety 

Tylka, TL. J. Counseling Psychology 2006;53:226­240. www.EvelynTribole.com

What the Research Shows 2008 BED Study

5

4

8 Weeks

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Intuitive Eating Intervention  n=31 DSM-IV BED criteria CBT, IP, DBT 

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Smitham, L. Evaluating an Intuitive Eating Program for Binge Eating Disorder: A Benchmarking Study  (Dissertation).University of Notre Dame. 26 November 2008

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What the Research Shows  What the Research Shows Intuitive Eater Characteristics   BMI   Wellbeing    HDL   Triglycerides   Self esteem   Thin idealization *Tylka, TL. J Counseling Psychology. 53(2):226, 2006.    Smith TS & Hawks, SR. Am J Health Edu. 2006;37(3):130. www.IntuitiveEating.org 

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Intuitive Eating  Principles

1.

Reject Diet Mentality

l

Honor Your Hunger

l

Make Peace w/Food

l l

Challenge Food Police Feel Your Fullness

6.  Discover Satisfaction

7.  Cope without Food 8.  Respect Your Body

9.  Exercise­Enjoyable Feel 10. Honor Your Health­ Gentle Nutrition

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Our “Story” & Influences       

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LL Birch Hirschmann & Munter  Geneen Roth Ellyn Satter Habituation Restraint Theory

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Brief History • • • • • • • • •

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1995 Intuitive Eating, first ed. 2003 Intuitive Eating, 2nd ed. 2005 Linda Bacon JADA 2005 Stephen Hawks 2006 Tracy Tylka 2006 Wikipedia 2006 People Magazine 2008 Univ. Notre Dame 2009 JADA (in press)

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Attunement Barriers In Eating Disorders

• Primal Hunger Issues

 “Hunger Meter Broken”  “Satiety Meter Broken”

• Rigid External Rules & Beliefs  Food  Nutrition  Body

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Attunement Barriers In Eating Disorders • Exercise­External Based

 Calories burned vs intention  “Satiety Meter Broken”

• Trust Issues  Self  Body

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Getting Basic Needs Met? • • • • • 

Self­care Sleep Transition Time Friendships Boundaries

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Patient Expertise Thoughts Feelings Experiences Missing Factors Trust Empowerment Acceptance Mindfulness

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Readiness for Intuitive  Eating • • •

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Biological Restoration Balance Recognition­­ED not  about weight or food

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Readiness for Intuitive  Eating Ability & Willingness: • Deal with Feelings • ID Wants and Needs • Take Risks

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What’s Your Thermostat?  Pleasant?

 Unpleasant?  Neutral?

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Intuitive Eating Principles  1.

Reject Diet Mentality

l

Honor Your Hunger

l

Make Peace w/Food

l l

Challenge Food Police Feel Your Fullness

6.  Discover Satisfaction 7.  Cope without Food 8.  Respect Your Body

9.  Exercise­Enjoyable Feel 10. Honor Your Health­Gentle Nutrition

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PRINCIPLE 1:

REJECT DIET MENTALITY • Primal Hunger • Biology • Psychology

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PRINCIPLE 2: 

HONOR YOUR HUNGER Primal Hunger

• Regular Meals • Biological Balance • Timing               www.EvelynTribole.com

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“I can’t be hungry…” Reframe Context

• “Meal Hungry” • Exercise • Last Meal/snack

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Guided Activity HUNGER  AWARENESS

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PRINCIPLE 5: 

FEEL YOUR FULLNESS • Rate 1­10 • Not Sure? • Pain vs. Comfort

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Fullness Nuances

Comfortable & Nourished

“Gap”

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Satiety Cues Exceptions • • • • • 

Stress Illness Mood Disorder Eating Disorder Intense Exercise

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PRINCIPLE 3:   MAKE PEACE with FOOD             MAKE PEACE with FOOD • • • • • 

Take Risks Add New Foods When Ready ID Vulnerability Baby Steps

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Food Habituation Studies   Exposure    Response

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Habituation & Dieters  • No Habituation Experience • Instead, Food is:

Exciting & Scary Must be controlled 

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What To Expect • Excitement • Every meal • Every day • Normal • Wanes

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PRINCIPLE 4:  

CHALLENGE FOOD POLICE Remove:

✔ Morality

✔ Judgment ✔ Shame

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“I feel guilty because I ate…” 

Lunaea Weatherstone

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PRINCIPLE 9:  

JOYFUL EXERCISE

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When Does Nutrition Fit In?   Readiness Free From: • Morality in Eating • Dichotomous Thinking • One­Bite­Away  Disaster

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PRINCIPLE 10: 

 GENTLE NUTRITION • Not Rigid Rules • Not Knowledge Issue

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Resources Intuitive Eating Practices Audio CD Intuitive Eating Pro­­ Skills Training 

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