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Eating with Wisdom: Cultivating Mindful Eating. Jean L. Kristeller, Ph.D. Center for the Study of Health, Religion, and Spirituality The Center for Mindful Eating www.tcme.org Dept. Of Psychology, Indiana State University j-kristeller@indstate.edu. Acknowledgments.
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Eating with Wisdom:Cultivating Mindful Eating Jean L. Kristeller, Ph.D. Center for the Study of Health, Religion, and Spirituality The Center for Mindful Eating www.tcme.org Dept. Of Psychology, Indiana State University j-kristeller@indstate.edu
Acknowledgments Indiana State UniversityBrendan Hallett, Psy.D. and Virgil Sheets, Ph.D.Juli Buchanan, M.A., Brandy Dean, M.A., and Janis Leigh, B.A. Duke UniversityRuth Quillian-Wolever, Ph.D. Sasha Loring, M.S.W., Jennifer Davis, M.S., and Jennifer Best, Ph.D. Richard Surwit, Ph.D. and Richard Liebowitz, M.D.
MINDFULNESS: a cognitive state, marked by attentional stability, that disengages habitual reactions and allows for inner wisdom to emerge.
Meditation:Mechanisms and Misunderstandings • Meditation is NOT primarily a trance state. • Meditation is NOT primarily a relaxation tool. • Meditation is FUNDAMENTALLY a cognitive-attentional process that promotes self-regulation. • It has potential effects across MULTIPLE DOMAINS of psychological functioning: cognitive, physiological, emotional, behavioral, relation to self/others, and spiritual.
Usual Processing: Conditioning Model & Eating Problems Usual Thoughts and Experiences Conditioning ~~ Survival ~~ Attachment/Avoidance XX Cognition/Attention Emotions Self/Others Physiology/Health Spiritual Behavior
The Six Domain Model: Eating Mindlessly • Cognitive: Preoccupation with food/eating; black and white thinking. • Physiological: 1) hyper-reactivity around food. 2) Disconnect from normal hunger and satiation cues. • Emotional: Depression; craving; anxiety. • Behavioral: Binge eating; highly conditioned responses to food; general overeating. • Relationship to Self/Others: Poor self-acceptance; self-hatred; anger at others; over-valuing thinness. • Spiritual: No wise eating; spirituality does not engage honoring body; value and meaning attached to food abundance.
Psychiatric Criteria for Binge Eating Disorder (DSM-IV) • Recurrent binges, characterized by: • Eating, in a discrete period of time, much more than most people would eat. • A sense of lack of control during the episode. • At least two episodes of binge eating per week for six months. • Associated with eating more rapidly, eating until uncomfortably full, eating without being physically hungry &/or feeling very guilty or depressed afterwards. • Marked distress regarding binge eating.
Overeating Pattern Time KCal 7 am 2 eggs, bacon 2 slices toast OJ 450 10 am Doughnut 150 Noon Whopper Medium Fries 1130 6 pm 6 oz. Steak Baked potato 2 vegies, roll Apple pie 1320 10 pm 2 oz. Doritos 1 beer 450 TOTAL 3500 Bingeing Pattern Kcal Cereal/milk OJ 260 Salad/diet dressing Roll Diet Coke 300 3 oz steak Baked potato 2 vegies 500 2 pieces Apple pie 7 oz. Doritos 1 pint ice cream 2440 TOTAL 3500 3500 KCalories: Overeating vs. Bingeing
MB-EAT:Mindfulness-Based Eating Awareness Training • Mindfulness meditation • Eating experience meditations: • Awareness of binge triggers • Awareness of hunger • Awareness of satiety (taste-specific, fullness) • Food-related meditations: raisin, chocolate, cheese/crackers, pot luck meal/buffet. • Mini-meditations with daily meals and snacks. • Forgiveness and wisdom meditations • Homework: meditation practice, mindful eating.
MB-EAT: Outline of Sessions • Introduction to mindfulness meditation. Mindfully eating a raisin. • Introduction to “mini-meditation”. Mindfully eating cheese and crackers. • Binge trigger meditation. Mindfully eating sweet, high fat food. • Hunger Signals meditation (physical vs. emotional hunger). • Taste-Specific Satiation Signals meditation. Chips and cookies. • Stomach Fullness Satiety meditation. Pot luck meal. • Forgiveness meditation. • Wisdom meditation. • Have others noticed?; where do you go from here?
NIH Trial • NCCAM-funded randomized clinical trial with 3 groups: Meditation-based; Psycho-educational; Waiting List. • Two-site design (ISU and Duke). • 9 week manualized intervention • 1 and 4 month followups • More extensive measures including process measures and change in biological markers of self-regulation (lipid and metabolic profiles)
Sample • Sample size: N = 150 evaluated on all baseline measures; 14% men. • Approximately 14% African-American recruitment • Average age = 47.5; Avg. Wt. = 240 lbs.; Avg. BMI = 39.
Changes in Number of Binges in Previous Month p<.01 (N =85)
Treatment Effects on Beck Depression Scale p<.001 (N =85)
Treatment Effects on the Three Factor Questionnaire: Disinhibition p<.001 MM vs. PE: p <.01 (N =85)
Treatment Effects on the Three Factor Questionnaire: Hunger p<.001 MM vs. PE: p <.10 (N =85)
Treatment Effects on Lowe’s Power of Food Scale p<.001; MB vs. PE: p<.10 (N =85)
Treatment Effects on Weight (N =85)
Relationship Between Practice and Improvement in Relation to Eating(n = 31-34)
Results in Relation to the Multi-Domain Model • Cognitive: Disengagement from food preoccupation. • Physiological: Normalization of hunger and satiation cues; improvement in physiological/metabolic regulation. • Emotional: Decreased depression. • Behavioral: Decreased binging, interruption of highly conditioned responses. • Relationship to Self/Others: Improved self-acceptance; anecdotally, forgiveness of others. • Spiritual: Anecdotally, sense of connecting with the higher, wiser self; using meditation as prayer time.
Current NIH Study: MB-EAT IIMindfulness Meditation: Regulating Eating and ObesityPI: Jean L. Kristeller, Ph.D., ISU • NCCAM-funded randomized clinical trial with 2 groups: MB-EAT vs. Wait List Control. • Focus on obesity - moderately to morbidly obese (BMI>34). • 12 week manualized intervention with increased focus on weight loss, plus 3 month support followup. • 6 month total followup.
j-kristeller@indstate.eduThe Center for Mindful Eatingwww.TCME.org