Counselling Psychology

Mindfulness treatment of eating disorders: A qualitative analysis of therapists’ experiences Nadia Mysliwiec & Dr. Mark Thorpe and Dr. Rhoda Scherman Counselling Psychology

Aim • To gain in-depth knowledge of the lived experiences of therapists using mindfulness as a therapeutic tool with clients diagnosed with an eating disorder.

Background • What is Mindfulness? • Lifetime prevalence of eating disorders is currently around 5% • Anorexia Nervosa – 0.6% • Bulimia Nervosa – 1% • Binge-Eating Disorder – 3% (Treasure, Claudino & Zucker, 2010)

Issue and Context • Studies offer a strong case for the use of mindfulness-based therapies and the consequent benefits for individuals diagnosed with an eating disorder.

Method • Qualitative research using Thematic Analysis (Braun & Clarke, 2006) • 5 Participants Thank you again! • Interviews and case studies

Themes

Mindfulness Benefits the Therapist A sense of calm Building the therapeutic relationship

A sense of calm Mindfulness has been crucial in me feeling calm in this job… When I reflect back on when I was feeling really stretched I wasn’t doing mindfulness, but now that I am again I’m feeling really calm and I don’t get stuck like that. The more relaxed I am now, the better therapist I am. I think mindfulness is crucial, particularly with these eating disorders, which are so highly charged. (Jasmine)

Building the therapeutic relationship It always feels very connecting. There is a realness felt; a heart felt connection, or something that feels more real versus other symptoms, such as anxiety. So there’s something about more of a felt, real, connection with another human being… a positive connection. (Rachel)

Crafty and Creative Mindfulness needs to be relevant to the individual Age matters Mindfulness needs to be applicable to specific eating disorder diagnosis Working through the pain Building mindfulness capacity

Mindfulness needs to be relevant for the individual There’s skill in making something acceptable and useable, and that’s the bit that I really enjoy. I sometimes feel a bit crafty about it… Potentially quite powerful stuff too… Mindfulness is potentially a way to get through eating disorders… So, you’re not teaching them how to observe sound specifically; rather, it’s an exercise to demonstrate a concept… I suppose it brings it down to something less abstract, not necessarily concrete but less out there. I suppose that’s why I reframe it, and I mean it makes sense for me too to reframe it. (Esther)

Age matters I have found that generally it’s harder with adolescents doing mindfulness. It’s much easier with adults, because there’s something about a level of depth or a level of psychological understanding that a teenager might just criticise [mindfulness]. (Rachel)

Mindfulness needs to be applicable to specific eating disorder diagnosis I use mindfulness in a different way, or perhaps I get a different success, with the [different] client groups… If I were to rate them I would find it harder with anorexia, I find it relevant with binge-eating disorder, but it also takes quite a long time, whereas people with bulimia seem to, in my experience, pick it up quicker… Someone with bulimia is more chaotic and their emotions are stronger, so I find that mindfulness can be quite good to help… Anorexia is different again... they’re so overwhelmed with their anxiety often, and they don’t even recognise it as that, so [mindfulness] just doesn’t seem relevant for them. (Rachel)

Working through the pain A lot of the times I think when people use mindfulness skills they tended to avoid their emotions a lot, and then they end up feeling a lot worse, well not worse, just feeling, which then feels worse… So noticing what happens when you pay more attention to difficult behaviours, and we also have to notice that we feel bad about it… people tend to collapse into a lot of shame, but they still need to recognise that binging all evening actually makes them feel awful, and that’s valid. (Josephine)

Building mindfulness capacity Those who consistently think [mindfulness is] hard… are told to read a magazine for a couple minutes and then try again. So it’s very much about building a capacity, even if that’s just thirty seconds to start with… They have to be willing to give it a go. (Josephine)

Motivation and Practice are Key Motivation is vital Practice, practice, practice

Motivation is vital At the beginning of treating eating disorders it’s more about motivation… If they haven’t got that motivation they won’t have motivation to do mindfulness… It’s not something you can force someone to do. (Anne)

Practice, practice, practice If you’re building an arm muscle you do things with weights that you don’t do anywhere else in your life and you’re doing it to increase something and get stronger, and it’s the same with mindfulness exercises, like when we just observe sound, which we don’t usually do on a day to day basis, however, doing it helps us build this ability. (Esther)

Mindfulness Feels Relevant Mindfulness feels logical Mindfulness alleviates anxiety The philosophy of mindfulness feels satisfying

Mindfulness feels logical My sense is that this works beautifully for eating disorders, like in terms of them normally being so wrapped up and connected to their thoughts. If they can separate themselves from it… like it makes logical sense that it would work really well. It just has so much potential. For anorexia there are so few things that do work, I think that this really could be quite ground breaking. (Jasmine)

Mindfulness alleviates anxiety Because she’s so anxious, I would say it would be quite hard [not to use mindfulness]… A lot of it is about bringing herself back, so like a grounding use of mindfulness. For her it’s quite essential, and I’ve seen her now for three years, and it’s still very crucial. (Anne)

The philosophy of mindfulness feels satisfying I really enjoy mindfulness techniques. It feels more satisfying. It feels more rich, or deep, or philosophically relevant… It feels relevant and philosophically in tune. (Rachel) It’s sort of the opposite to what a lot of things, and our culture, seems to be going towards. And so I think there is this tension between life speeding up and people working harder… I can only see it becoming more and more required actually… It’s good to be able to package something up, which mindfulness does, and describe something that is fundamental to how you live an emotionally less distressing life… I think that the fact people are speeding up may potentially open up the fact that people need mindfulness. (Josephine)

Conclusion • Mindfulness for the therapist • Mindfulness for the client • The general relevance of mindfulness

Avenues for future research • My Masters research: • The aim of my current research is to gain in-depth knowledge of the turning points in therapy, as experienced by therapists using mindfulness as a therapeutic tool, with clients diagnosed with Bulimia Nervosa.

A big thank you to the Institute of Counselling Psychology for your support. questions? Thank you

Counselling Psychology