Month: June 2012

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Carolyn Ross: “Treatment for Eating Disorders With the Integrative Approach”

Morty: Hi Carolyn. Thank you so much for being willing to be part of our podcast series on treatment for eating disorders.

Carolyn: Thank you for having me on, Morty.

Morty: My pleasure. This is Morty Lefkoe with our weekly podcast and interview. We’re very fortunate today to have Dr. Carolyn Coker Ross. She is a physician who has some unique approaches to treatment for eating disorders.

We’re going to talk to her for a little while. She’s worked with Dr. Andrew Weil who is one of the major names in integrative medicine and she’s done a lot of really interesting things. I’m personally interested in hearing what she has to say myself.

So Carolyn would you mind just introducing yourself and telling us where you’re located, and then how you got started in this field.

Carolyn: I’m located in Denver although most of my work is located outside Denver. I travel all over the country and also to some other countries to talk about eating disorders and addictions. And I work as a consultant, primarily currently in this drug and alcohol rehab facility that also has an eating disorder program called “The Ranch,” which is near Nashville, Tennessee.

I’m also a writer. I’m working on my fourth book as we speak.

Denver is my home base though. I got started working with eating disorders through my work with obesity, which I’ve always considered as part of the spectrum of eating disorders.

Eventually I then became a medical director for an eating disorder center in San Diego where I was practicing. And then later worked at Sierra Tucson and was the head of their eating disorder program. And now, as I said, I’m a consultant for The Ranch’s eating disorder program.

Morty: So did you actually work with people directly yourself or do you work through a clinic or are you just a consultant to the clinic?

Carolyn: I do all of the above. I have my own private practice in Denver where I work with people individually. I also do supervision of–or training I should say–of therapists in the centers where I consult. I often will sit in on client interviews or therapy sessions with sessions and also in groups. I do a little bit of all of that.

Morty: How would you describe the problem? I personally call it emotional eating. Because from my point of view, overeating is really the result of eating when you’re not hungry because of emotional reasons for the most part.

Carolyn: Are you speaking just of the eating disorder that is called emotional eating or are you speaking of all of the eating disorders?

Morty: I guess there are some emotional problems in anorexia or bulimia too, but I’m speaking mainly of overeating, which is the problem that most of the people who’d be listening to this podcast are having a problem with.

Carolyn: Well my favorite saying is “It’s not about the food, it’s about the pain.” And I think eating is often in response to some discomfort. Whether it be related to emotions at work you’re experiencing, or stress or trauma or neglect. Beliefs that you have that are related to past experiences. All of those culminate in discomfort or pain, and we usually overeat to work through the pain or to numb ourselves from the pain.

I just recently read an old interview dating back in the 1990s with Oprah Winfrey who stated that she never realized that she felt stressed–which is hard to believe–because she ate her way through it. I think that’s a typical experience of people who are overeaters. They may have even lost track of the reason why they are overeating. But there is that pain that then leads to overeating behaviors.

Morty: What is your basic theory as to the source of why people end up eating rather than something else, if they have pain? Number two is, what’s your basic approach to helping people resolve that problem?

Carolyn: I think that most of the issues usually start with experiences that we’ve had when we were younger. I can give you the example of a client that I had some years ago who was a compulsive eater. He had a lot of sibling rivalry with his older brother. So when he got to be bigger than his older brother, for the first time in his life he felt safe. His older brother couldn’t beat him up.

This seems like maybe a small thing but we’re seeing a lot of this come up with kids who are getting bullied. Then ten years down the line they have overeating and obesity issues. And they can point back and say, “I was bullied, I was teased, and that’s when things began.”

From there, people starting in that moment have emotions that come up that often they may not tell anybody about or they may not have someone who responds to it in an appropriate manner. Then those emotions lead to beliefs that then create a kind of dynamic in their lives where they are that they may even have forgotten.

So in the case of the young man for example who had the older brother beating him up all the time, his belief that he’d formed in that time period was “Bigger is better”. Because bigger was safer for him. For many women you see that too. Women who’ve been abused or raped. They may feel that being bigger gives them a safety factor. Those beliefs then drive the behaviors. But I think underlying all of that is what I call a lack of soul satisfaction.

Many people are not able to express themselves authentically because of the reasons that I just mentioned. So part of them is really shut down.

What I find in all the eating disorders is that when you are able to really get back in touch with your true self, who you really are, whether it be “I am a powerful person, I don’t need to be heavy in order to be safe” or “There are other ways that I can get my needs met without using food.”

Beyond that, if your career is satisfying if your relationships are satisfying, then food becomes much, much less important.

Morty: What are the kinds of beliefs you find? Is your conclusion then that the primary source of overeating, emotional eating, is beliefs?

Carolyn: No, I go one step further Morty. I believe that beyond the core beliefs is this desire of the soul for expression. I think we have experiences in our lives that in some ways kill a part of our souls. Like when a child is bullied or when a child is abused. You’ve heard the expression that when you abuse a child, it takes away a part actually of who they could be. That’s what I’m talking about.

I think the beliefs are one level at which there’s a lot of work to be done. And once you can help people get back in touch with those beliefs, then the next step though is to help them understand how those beliefs came about and how those beliefs have actually stolen who they could have been.

Morty: What is your technique or what is your approach to both eliminating the belief and dealing with the soul expression? Merely letting people know they have the beliefs or that they’ve suppressed them? Their expression is sufficient, is it?

Carolyn: No. The best way to tell you about this is to tell you about a patient I saw who lives in the Bay area. She was severely anorexic. Now this is the opposite end of the spectrum but the problem is exactly the same. She was very, very successful in her career but not happy with that career. She’d been anorexic since she was a young child and had issues with her family and lots of younger child issues. So she became aware that her belief was “In order to be loved, I need to be thin.”

Many people who are obese feel the same. That they can’t have a relationship. They can’t have the life or the job they want. They can’t change careers. They can’t have children until they become thin. This really steals a big portion of your life. And for her, it had been over two decades that she had been struggling with her disease.

She decided to go back to school although she was still in the throes of anorexia, continued working on her disease and got her degree, developed a new career in which she was extremely happy and eventually started regaining her weight without any further treatment.

I think that is just an illustration that a lot of people say “I’ll be happy when I lose weight.” What I tell my patients is, “When you get happy, you’ll lose weight. So it’s really about looking at the big picture. We focus so much on the number on the scale and “If I can just get that number down then everything would work out.” But a hundred percent of the people I’ve worked with will admit that even when they were at their thinnest, their lives weren’t still where they wanted them to be.

So it’s really a process over time of identifying those beliefs. Getting the experience of how those beliefs have affected your life. That can be through experiential therapies like psychodrama or somatic experiencing. Using the body to help you do guided imagery that gives you a felt sense of the effects of those beliefs. Then as you get that felt sense, you can start to take action. To change the things that need to be changed. Starting with the belief, just making a statement about what you want in your life and then starting to just go through the process of making those changes.

Morty: So are you saying that basically, doing things that will make you happy and changing your experience of life will get rid of the eating disorder or is there a step in the middle there someplace?

Carolyn: Well the step in the middle is the one that we have been talking about. Which is recognizing the influences that have caused the overeating. Was it neglect when you were younger? Was it trauma? Was it abuse? What are the things that have caused your problem? Were there emotional issues that then led to beliefs? So awareness is the first step.

Then the second, third, fourth, fifth step is working through and processing what happened to you with someone who’s qualified to do that. So it’s just like any other process. Like the grief process. You lose a loved one, you can cry for months but then it’s still not over. So you have to work on different layers of the emotional overeating until people start to see that the deepest layer is “What’s going to satisfy my soul?”

One of the questions I ask in some of the conferences I do is, “If you were to focus on doing the things that satisfied your spirit, your soul, your deeper self, how would your food intake be different? How would your level of activity be different?”

I think it’s connecting to that deepest urge that we all have inside of us. I’m not talking about religion. I’m talking about that deepest urge that we have to be fully ourselves and to express ourselves fully. When we are able to do that, a lot of other things fall into place. But you have to do that groundwork which usually occurs in therapy or with groups.

I have a book called The Binge Eating and Compulsive Overeating Workbook. And I’ve had so many people come up to me in talks and say, “You know, I’ve used your workbook. That helped me get into understanding what happened to me and become more aware of my beliefs and make those changes.” And so on.

So there are different ways you can do it. But you have to do that groundwork.

Morty: What influence did Andrew Weil have? I read that you had a two-year fellowship in Integrative medicine with Dr. Weil. How did that affect your approach to treatment for eating disorders?

Carolyn: My entire approach for treating eating disorders is an integrative medicine approach. I’ve done that from the very beginning at my first position in Sierra Tucson. What that means essentially from my point of view is really looking at the whole person. So you’re not just looking at what’s happening to the body, what the number on the scale is, how many calories someone eats. I don’t even look at calories anymore.

It’s really about looking at all of the influences. That could be spiritual influences. It could be physical, mental, emotional, et cetera.

As well, in the integrative approach, which I describe in my books–obviously I use nutrition because that should always be the first tool for anybody who has any of the eating disorders. But we also use dietary supplements to help the brain function better.

Many people with eating disorders including those who are overweight or obese have nutritional deficiency. They’re undernourished even though they may be overweight. So we use supplements to replace nutritional deficiencies. To support mood. Because emotional eating is directly connected with our moods and particularly people who suffer depression or anxiety etc. But even without that, having your moods be more stable is also very helpful.

Then also, supplements are important to help with digestion and absorption of the foods that you eat. And amino acid therapies that work with the brain to help reduce cravings and improve cognitive functioning and decision making. All of that.

Morty: I read that you developed your own line of supplements. Did you research what was needed by people who are overweight and have an eating disorder?

Carolyn: Absolutely. It’s called the “Basic Recovery Support.” I also have a new formula called the “Crave Free Formula” which involves the use of the amino acids such as tryptophan and tyrosine and those that help reduce cravings. Both of those formulas are available on my website. If people are interested, there’s a lot of information on them.

We did do research that looked at the use of those supplements and found that they help with sleep and also with reducing digestive problems. The research showed both of those areas that it was a statistically significant benefit over and above the use of traditional Western therapies such as sleeping pills or Metamucil for digestion.

Morty: I want to ask you some more questions. But for people who are interested we’ve got to give your website and that’s carolynrossmd.com. That’s C-A-R-O-L-Y-N. Carolyn Ross R-O-S-S and then because you’re an MD, Carolyn Ross M as in Mary, D as in David, dot com. So carolynrossmd.com.

Carolyn: I also want people to know that I do have another website which is called “The Anchor Weight Management Program” site. That’s www.findingyouranchor.com. That’s my weight management program where I offer webinars. I have a webinar weight management program that’s running right now and we’ll have another one starting next month.

The reason it’s called “The Anchor Program” is because of what I was saying to you. Being anchored is being really true to yourself and accessing your inner strength rather than looking to external sources for validation, the “Yes you’re pretty, yes you’re thin enough, yes you’re okay. The number on the scale makes you okay.” It’s about really looking inside for that inner strength to give yourself what you need.

Morty: So you basically have courses, you have individual treatment, you have internet courses, you have books. You’ve done a little bit of all of it, right?

Carolyn: That’s right. Yeah.

Morty: If somebody wanted to work with you directly do you work with people on the phone or Skype or do they have to be in your area?

Carolyn: No, I work with a lot of people by phone. And if they’re interested enough they go to findingyouranchor.com and they can either send me a message about a webinar or about individual consultations via that website. Or about programs in Denver.

Morty: But your programs are in Denver though.

Carolyn: The in-person programs are in Denver, but like I said, right now I’m running a webinar program, which is a group program for weight management. This one is a four-week program. In August we’ll be starting a ten-week program by
webinar. So if people live outside of Denver they can still work with me in a group setting via the webinar.

Morty: How would you describe the difference between your approach and the hundreds of other approaches? Is there a specific way in which you would distinguish it?

Carolyn: Absolutely. I can tell you the biggest difference is I do not believe in dieting. I don’t use a diet, I use simple guidelines for nutrition. The biggest thing that I can guarantee to people is not that you’re going to lose fifty pounds in two days. Which I think is–you know, all of the studies have shown that diets do not work no matter how nice the diet is or how hard you try. So my goal is to put people in a path where they can have lifelong success rather than just momentary success.

So I can guarantee people that they’ll stop feeling uncomfortable around food, they’ll be more able to choose foods, they’ll be able to eat the foods they like and not gain weight and they’ll lose weight. But slowly. And they’ll also stop hating their bodies. I think that once you do those two things–if you hate your body, why would you take care of it? So starting to have that partnership with your body–you know, the body is really where all of the knowledge and the wisdom is on what you need to do to be successful in reaching a healthy weight.

Instead of working with the body, most diets are about punishing the body, depriving the body, beating the body up with exercise. Look at “The Biggest Loser.” That’s a great example of how you’re not working with your body. Most of the people who go through that, well they may lose weight on the show but they do not keep that weight off.

So that’s the big difference. I’m not as focused on getting you to that rapid weight loss. People who go through my program do lose weight, but more importantly, they learn to keep it off.

Morty: I understand and agree with that totally. I also tell people who work with us the same thing. That gaining weight or losing weight is a function of so many things. Your endocrine system, the kind of food you eat, etc. What I can guarantee and certainly what you do is you’ll stop emotional eating, you’ll stop eating when you’re not hungry. You’ll stop eating for emotional reasons. And that usually will lead to a loss of weight. Losing weight is the consequence of dealing with the emotional issue, which is really the source of the problem.

Carolyn: Yeah and I think that also it’s important for people to refocus on their health first, and then weight. If you start eating not good foods–again, I don’t believe there are good foods or bad foods–but just eating foods that your body likes and that make you feel good, not emotionally good but physically good, then I think that emotional eating can definitely be reduced or gotten under control. We all do a little bit of emotional eating but it shouldn’t be to the point where it’s making you get fat or where it’s compromising your enjoyment in your life.

Morty: One other question. Have you ever done any research or any follow-up on the people to see if it lasts? Because there are so many people who are able to stop eating using willpower for short periods of time. So sometimes it looks like some sort of treatment has worked but when the willpower runs out, they’re right back where they started. So in order to see that any particular treatment plan really works you need to be checking in three or six months or even a year later. Have you ever done any follow-up like that to see what the long-term results are?

Carolyn: Some of my patients I’ve been working with for more than three years so I do have follow-up for those people. And like I said, the big important thing is that they are able to lose weight but more importantly, able to keep it off. I don’t have a large sample in my practice right now where I could do that follow-up. But in one of the other treatment centers where I worked at, we did follow-up for two years and found that people were keeping off at least ten percent of the weight that they had lost. That’s really better than the industry standard.

Again my goal is if you can learn to keep it off–I think most people learn how to lose weight. But they don’t know how to keep it off. So learning those skills will help you in the long run to eventually reach that weight. What I do is what I call the “Step Approach,” which is to help people lose a certain amount of weight like ten percent and then to maintain that weight for several months. Then lose another five to ten percent and then maintain. So again you’re really getting the muscle to keep the weight off.

Morty: Great. Well thank you so very much, this is really interesting material. It’s a different approach, it’s a more spiritual approach that seems like a lot of other weight loss, eating disorder, or treatment programs should include.

For people who would like to follow up with Carolyn, you can reach her at findingyouranchor.com and you can find out about her group program webinars there or you can find out about individual consultation programs with her. She also works as a consultant in a couple of clinics and you can find out about those clinics if it turns out that’s the best way for you to go. So findingyouranchor.com and also her other website is carolynrossmd.com.

So thank you so much Carolyn, I really appreciate your time.

Carolyn: Thank you Morty. It’s been great being on with you. Thanks again.

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MORTY: Hello, Karen! How are you today?

KAREN: I’m fine. How are you?

MORTY: Great. Thank you so much for being willing to spend a few minutes with us. We’ve got a bunch of listeners and people who are going to want to read this interview, who are interested in how to stop overeating.  They are interested in understanding better what has caused their emotional eating problem, what’s involved in it, and perhaps some new ideas on what to do about it.

Why don’t you tell us a little bit about your background, what makes you an expert in this area, and what you think you might be able to offer to our readers.

KAREN: I’m an expert both professionally and personally. I have a Master’s in Education, and I have a Master’s in Social Work, and I have been what I consider an expert on the psychology of eating, which is the how and the why, not the what, for more than 30 years.

Personally, I am a former chronic dieter, and what I consider a world-class binge eater, certainly an emotional eater, and I have been a relatively normal eater since the 1980s.

MORTY: Okay.

KAREN: I use my expertise that I learned educationally, and I use what has worked for me, and readings in the field to help people learn how to stop overeating.

MORTY: Okay. It sounds like an interesting background with some personal and professional expertise on it. Did you have an institute, a clinic, or are you a private therapist? How do you help people?

KAREN: I’m the author of four books on eating and weight. I can certainly talk about those.

MORTY: Would you please name your books, so that people can possibly check them out if they’d like to?

KAREN: Sure. These are in the order that they’re written. The Rules of Normal Eating is my first book, and that gives basic guidelines to connect to appetite, hunger, food preference, satisfaction, and fullness.

My second book is the Food and Feelings Workbook, which deals specifically with emotional eating and lays out what emotions are for, why do we have them, how can we use them, and how can we stop eating and connect with feelings, so that we have a better life.

My third book is What Every Therapist Needs to Know about Treating Eating and Weight Issues. It is for non-eating-disorder therapists, general therapists who have clients with eating and weight problems.

My fourth book is Nice Girls Finish Fat – Put Yourself First and Change Your Eating Forever. That is for all the women out there who take care of everybody else with their warm feeling and kindness and loving hearts and then, as I describe it, take care of themselves through multiple trips to the refrigerator.

MORTY: I got it. Okay, well, thank you. You’ve got a lot of material that we could take a look at. Let’s just start. I have called the problem emotional eating, and I’ve had a lot of therapists and other authors disagree and call it other things, such as compulsive eating or addiction, etc.

I call it emotional eating because it seems that the, although there are obviously differences with different people, the main source of the problem is that people have negative feelings—anything from boredom to feeling unlovable to anxiety to anger, etc. They use eating as a way to keep down, to get rid of, to cope with these negative feelings. I call it emotional eating because they’re compulsively driven to eat by their emotions.

Do you see it that way? Or, if not, how do you see the issue of compulsive overeating?

KAREN: I also call it emotional eating. I do differentiate between what I would call compulsive eating, you’re watching a basketball game, and your hands are in the chips, and you just keep feeding yourself. I think that’s when we sometimes just get out of touch with our appetite. I would call that compulsive eating. I think there can be a problem.

However, emotional eating has this specific intent to avoid or lessen internal distress through food. I think, as well, that people have bad habits that you can call it non-hunger eating. You could call it “cued eating.” A client was telling me she’s been really enjoying food, eating healthfully, and then there were five cookies leftover in the teacher’s room, and she just ate them all. I think that was just mindless.

MORTY: You don’t think there was an emotional reason? You just think that this was almost like accidental that it wasn’t being driven by some emotion that she wasn’t aware of?

KAREN: I don’t think in that particular moment that it was an emotional response. I think it just wasn’t thinking because for decades she has gone to the teacher’s room, and sort of “Hoovered” all the food that’s left on the table. I think in that case.

But, I do believe that most of the unwanted or troubled eating that goes on is emotional eating as you had described.

MORTY: How would you then describe from your point of view, the basic source of the problem, or how do you think the problem develops?

KAREN: Well, I think it develops when we are first held by a nurturing person, and we are fed and we feel contained and secure and comfortable and comforted. That makes the connection between food and feeling. Mother’s milk gets us drowsy. Carbohydrate, sugars, and fat do something similar. There is a natural relaxation response from certain foods.

We have a biological — most of us, not all of us– tendency to get that reaction from food; it changes our brain chemistry.

MORTY: If it’s something that everybody starts with, if the source of it is breast milk from a mother and how we respond initially, then, how come only half the people, or perhaps even less than that, end up with an emotional eating problem? If the source of it is something that’s common to everybody, then what else is there for people who ultimately develop the problem, and those who don’t? What distinguishes them?

KAREN: Okay, that’s a great question. I would speak to two fronts. One is that we are not all born with the same complement of neural transmitters that are mood regulators. Some people have a more high-strung or sensitive temperament from their genetics, and not having enough self-soothing neurotransmitters. They’re more likely to go to food.

Other people have a deficit of life skills, or self-soothing, or self-stimulation, whatever it is that food happens to do for those people.

Unfortunately, many people have both. They have the genetic propensity to be unable to self-soothe, relax, or stimulate with themselves, and they didn’t learn the life skills. That’s what I call a “double whammy.”  Those are the people for whom it is really hardest to overcome emotional eating.

MORTY: What do you do when somebody calls you up? You’re basically a private therapist working with individuals. Somebody calls you up and says, “I find that I can’t stop eating. I need help.” Basically, what is unique about what you do to help people overcome the problem of emotional eating?

KAREN: I work in several areas. One is I’m very interested in their beliefs about food, eating, emotions. We do a lot of identifying irrational beliefs, and how do you change them to rational beliefs? In that sense, I do a lot of cognitive behavioral work.

I help them build up life skills, how to say no, setting boundaries, problem solving, critical thinking skills, learning how to play, and relax, and let go, how to find passion and engage in life. Because when you can do these things effectively, you don’t want to turn to food. You just don’t think of it. I work on the life skills front.

One last front that I work on is I find many of my clients have mixed unconscious feelings about becoming a normal eater. It may be part of their identity.  An eating problem may be a way to say, “Look how I’ve suffered in life.” They may have mixed feelings about how hard they want to work on this, and just want it to be resolved quickly.

I work on the issues, the unconscious mixed feelings that they have. The major one I find is rebelling, that people will say, “I know what I should do, and then that little voice says to me, ‘Oh, eat the cookie. No big deal’, it’s telling you what to do. “

I call this section the boomerang effect—when we are told to do things over and over, we do two things, we tune out the information and then, we also rebel against it. I work a lot with clients on this whole idea of rebelling.

MORTY: Yes. I have found that a specific belief, people who feel powerless as one of their beliefs, I am powerless, then have the belief the way to be in control is to do what I want, when I want regardless of what I should or shouldn’t do, or regardless of what anybody wants me to do, or regardless of even what’s good for me.  Basically, by eating what you want when you want regardless of what makes sense, it gives you a sense of power and being in control what you don’t experience most of the time. I find that what you’re describing as that rebellion is actually the result of a specific belief.

KAREN: Yes. The belief is the result of whatever happened to people in childhood. Their sense of self was annihilated because they had very controlling, domineering parents. They’re going to want that part, sometimes called the wild child or just the self, to come out, and they do battle between that and the “should” and the “shouldn’ts.” I try to help them develop a nurturing self, which only has one goal, and that is to do what is in the best interest of the person. And–

MORTY: And … I’m sorry, go ahead. Keep going. I’m sorry.

KAREN: I was just going to say, and by developing that, this whole ping pong between I should, I shouldn’t, or rebelling, that whole ping pong match gets tossed out and you’re just focusing on what can I do now that is going to be best for myself.

MORTY: Your main technique is, you say, is cognitive behavioral therapy. That’s your main approach in working with these people?

KAREN: It’s a big part of it. Another approach that I use is trauma resolution that really has to do with people understanding, because there’s such a high correlation between eating problems, and trauma. It’s helping them understand them, when they have really intense feeling that they are generally from recall, not reality. Once they understand that, then the drive to eat lessens.

MORTY: Mm-hmm.

KAREN: Would you like me to explain that a little more?

MORTY: Sure yes.

KAREN: Okay.

MORTY:  I’m not sure that I understand what you mean.

KAREN: Okay. Let’s say that your father was alcoholic and came home, and you were scared the minute you heard him come in the house, and just the sounds of his feet on the stairs frightened you and then, he walks in the room, and somehow you got hurt.

If you’re in a situation where perhaps you’re waiting for someone, and you’re not knowing how they’re going to react when you see them, maybe you’re just in a job interview, and you hear that person coming up the stairs slowly, about to open the door to meet with you. You might have intense fear feelings, but it’s not because of the person who is going to interview you.  It’s because you’re stuck in recall. That’s what you’re reacting to.

I help people identify what’s stored in there, and what’s recall, and what’s reality. Once they’re in reality, they do much better managing them.

MORTY: Yes. I see that as conditioning, and we have a specific process to work on that. For me, the two major changes you’ve actually talked about are the same we work on, namely beliefs and conditioning.  I found about twenty triggers that when those triggers come up, as I say, which are mainly negative feelings, when they come up, you just find yourself eating because that is the way you’ve conditioned yourself to deal with those negative feelings.

KAREN: Yes, absolutely. It is a form of conditioning. I’ve been saying to clients, “You know we’re all rats at heart.”

MORTY: That’s right.

KAREN: We really are.

MORTY: Yes.

KAREN:  We respond to rewards and punishment.

MORTY: What would you say, do you have any sense to any follow up, not necessarily formal research on some informal basis, do you have any sense of what the effectiveness is, the recovery rate?

KAREN: I couldn’t give you numbers, but I will say that it is a long process, and that the people who stick with it, which are, I don’t know, many of clients do make changes in their eating, and in their lives.

MORTY: Do you follow up six months later to see, or do you have them call you? Or, do you have any?

KAREN: I do not.

MORTY: I don’t mean necessarily on a formal basis, but just for your own satisfaction to know how it’s going or you just basically, when you’re done, they seem to be in good shape, and you assume they’ll call you back if they still need you, and if they don’t, you assume all is well?

KAREN: Yes, to the latter. I don’t do for any formal or informal follow up. I do, it’s interesting, I run a Yahoo Food and Feelings message board. A good number of the people have been on it for a number of years, and so I can track their progress that way.

MORTY: Uh-huh, okay.

KAREN: That has been very interesting to see people who came on the board with no skills, and no clue how to stop emotional eating. Now, having resolved a lot of their issues, they are now helping new members on the board.

MORTY: That’s great. You said a moment ago, you said, if they stay with it, how long a process, I was talking with someone the other day who said, she has four 90-minute sessions, and that seems to handle the psychological element, and she has some nutritional and other kinds of work. How many sessions would you say, for the average person again, I know that everybody is very different and there’s a wide range, but roughly, what would the range be? If they stayed as long as you thought they needed to really get over the problem so that it’s gone, how long would you say your average client needs to stay?

KAREN: I don’t think in terms of sessions because I start off maybe with two or three weekly sessions, and I do mostly telephone and Skype for calling all over the world. I have a small private practice in here in Sarasota.  After that, people go to every two weeks, three weeks. For me, it’s not the number of sessions, but I would say from many months to a few years. Now, that doesn’t mean they need to be working with me that whole time.

I give people a treatment plan after the first session, and once they understand what the work is, some of it they do on their own. But, for me, it certainly was not a quick process. It was a thorough process, an organic process of changing, and not everything starts at the same place.

I’m thinking it takes quite a while for people to really be what they want to be, which is normal eaters, or relatively normal eaters.

MORTY: Where can people get some more information? Obviously, you’ve stated the names of your four books, but what website can people go to, to get more information about you and what you have to offer?

KAREN: The main website is http://www.eatingnormal.com.

MORTY: http://Eatingnormal.com.

KAREN: Yes. They can go to http://nicegirlsfinishfat.com, and I write eating blogs that you can find at http://bulimia.com. They can access my twice-weekly blogs, and if they go to Yahoo, and put in Food and Feelings message board, they can come up with my message board. I also have a free Facebook app on Emotional Eating, as it happens. If they put in Appetite Facebook app, they should be able to get it.

MORTY:  We have a lot of ways to find you Karen.

KAREN: Yes, anyway.

MORTY: Thank you so, so much. I so appreciate your time today. This is Karen, do you pronounce it Koenig?

KAREN: Koenig is fine.

MORTY: Yes, Karen Koenig, thank you so much for your time. I’m sure that my readers and listeners will be fascinated with your particular approach, your particular way of thinking about the problem of emotional eating. I’m sure that some of them will check out your books, or possibly get in touch with your directly.

Have a great day, and I look forward to talking to you at some point again soon.

KAREN: Okay, thank you so much, Morty! Bye.

MORTY: Bye.

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Morty: Hi. This is Morty Lefkoe with another podcast interview of somebody who has some ideas that might be useful to you on eating disorder recovery.. We’ve had authors and people who run clinics and today we have somebody who’s totally different. We have a hypnotist, a hypnotherapist who’s done some good work in a lot of different areas, including the area of eating disorder recovery,, who might have some really good ideas for you on how hypnosis might be a potential treatment for eating disorders. Estil, is that how you pronounce it?

Mr. Boyd: Estil.

Morty: Estil. Okay, it’s Estil Boyd. He’s the graduate of the Ohio Academy of Holistic Health and has been certified as a clinical hypnotherapist in 1998 and has had a private practice in the Oxford Ohio area since 1997. Estil thank you for coming and welcome to our show today.

Mr. Boyd: It’s a pleasure to be here, Morty.

Morty: Good. Could you give us a little bit of background on how you got interested in and started working in the area of emotional eating.  What is your specific treatment for eating disorders?

Mr. Boyd: Well, being a full service hypnotherapist I have had clients interested in weight management, which is usually the way it’s put to me. It’s always an issue that clients come to me for.  As far as emotional eating goes–one of the first things that I explain to people is that it makes a lot of sense that eating and emotions are closely tied together and it goes way back usually, to when we’re infants and we only have one way of communication. Once we cry, we get support. We get nurturing. We get physical contact and at the same time we get food.

It makes sense that we would associate the two with each other. So then in later life anytime that you’re feeling down, or depressed, or uncertain of yourself, maybe not feeling as good about yourself as you might like, it makes sense that one would find solace in food. In a lot of cases the emotional issue goes way back and is deeply seated by the time it becomes a problem for an adult.

Morty: Very interesting. I have one question based on what you said so far. You said you called it weight management. I like to make a distinction between emotional eating and weight.  I am actually able to tell people, “I can help you. I can almost guarantee to help you with your emotional eating. I have no idea what’s going to happen to your weight because weight is not only a question of how much you eat but the type of food you eat and exercise.

“If you are eating when you’re not hungry for emotional reasons–because you’re upset, you’re anxious, you’re bored, you feel unlovable, etc., I can figure out a way to help you stop doing that. But if all you eat are high carbs and you eat 5,000 calories a day and never get up from your desk, you’re going to gain weight even if you don’t have an emotional eating problem.” So I try to make a distinction between the two and it sounds as if you’re not making that distinction or are you?

Mr. Boyd:  Well, there’s a fair amount of guilt involved. People who eat emotionally never feel good about it. We’re such a visually oriented society these days that the compelling issue  that usually brings people to me is the way they look, their health, and things like that.

The first thing that I usually do my best to dispel is the whole idea of diet because it just doesn’t work. We’re hardwired, the unconscious mind is hardwired to protect this, to preserve this and if we threaten that unconscious mind with starvation, withholding food, it rebels. Now one can consciously overcome that for a while.

One can go on a diet and lose weight but eventually it comes back. The approach that I put forth is rather than denying yourself food, treat yourself to the proper kinds of food in the proper amounts.

Morty:   Okay but do you actually identify something that I call emotional eating, which is people who say, “when I have certain negative feelings–I am anxious, I am angry, I am sad, I am depressed, etc.,– I just find myself going to get food, and I have to use tremendous willpower to stop myself from eating or if I am eating I keep eating and eating even when I am full.”  I actually distinguish a particular behavior that is eating when you’re not hungry because you’re triggered by an emotion.

Mr. Boyd: Well, my intention is to re-channel that. If my client is feeling down, depressed, a situation where they would ordinarily go for food, well I am going to re-channel that to a more healthy choice. People feel that they have limited options. My job is to convince them that they always have options. In a place where they would have formerly gone for food, they have a walk instead. How about deep breathing? How about the things that are apt to uplift the body rather than drag it down?

Morty: Okay.  You actually acknowledge that there are emotional triggers to eat and what you do through hypnotherapy is get them to stop eating in response to the trigger and do something healthy in response to the trigger?

Mr. Boyd: Right but I am always going to put that in a positive way.

Morty: Got it.

Mr. Boyd: I am always going to phrase a suggestion positively rather than negatively.

Morty: So how would you do that? What would that sound like?

Mr. Boyd: I’ll talk about the good things they could do rather than the bad things they want to do. The unconscious mind doesn’t process negative very well. If I were to say, “Morty this is very important and your life depends on this. Whatever you do, don’t think about a blue tree.” Do you understand what it is I ask you not to do, you have to do it. For instance, you will never smoke again is a useless suggestion for a smoker.  You can now become a non-smoker is a much better suggestion.

Morty: Got it.

Mr. Boyd: So I am always going to phrase things in a positive way. So the suggestion would go like–in those times when you feel a little depressed or a little anxious, you can do this, you can do this. I am not going to talk about what they don’t want to do.

Morty: Got it. What is your experience–I always ask people who call with different techniques–what is your experience on the success rate of people no longer eating when they feel negative feelings and instead starting to go for a walk or whatever suggestions you make? To what extent, what percentage of the people, would you say are amenable to hypnotherapy as a solution to an eating problem?

Mr. Boyd: Well I think everybody is amenable to hypnotherapy. I have yet to find anyone who couldn’t do it.

Morty: Oh boy. Okay.

Mr. Boyd: One of the misconceptions because people think that hypnosis is something that a hypnotist does to you. That’s not what it is. Hypnotic trance is something that a person does. I just show them how. It’s not about one person’s control over another. It’s about self-control, taking charge of your own issues. Everybody that I have dealt with, I would say, at least 75% of them have positive results.

Morty: Oh boy, great.

Mr. Boyd: People move around, so it’s hard to keep track of your former clients, but that’s my gut reaction. I think probably 75% had some positive results.

Morty: Excellent. Congratulations. That’s exciting.

Mr. Boyd: It tends to generalize in a person’s life too. Once they have the techniques to deal with this issue, everything else seems better, as far as eating and exercise for instance. Once the person starts eating better and starts eating the proper diet and the proper amount, they’re going to be the one who rises so it’s much easier for them to exercise and they tend to want to.

We have an automatic system for weight management. It’s hardwired into us. It’s called the appetite. Now the problem comes because most Americans’ appetite are buried under about a meal and a half, but your body will tell you when it’s proper to eat. In its own–

Morty: What do you mean buried under a meal and a half?

Mr. Boyd: Well, most people don’t wait till they get hungry. They eat at a regular time of the day when their job or their regular schedule tells them it’s time to eat.

Morty: Okay.

Mr. Boyd: If they waited until they got hungry, their appetite would them when they’re hungry. Since they never let themselves get to that point, their appetite never gets engaged. They never notice it. One of the things that I stress with my weight management clients is it’s always proper to eat when you’re hungry and it’s always proper to stop eating when you’re not hungry anymore.

The appetite works exceptionally well if one pays attention to it and the idea is not to kill the appetite. The idea is to become friends with the appetite and as you go on and become better friends and get to know each other better, your appetite will not only tell you when you’re hungry, it will tell you what your body needs to eat at that time.

Morty: That I agree with totally. My experience in working with clients is that sometimes having to eat before you go to work at 7 o’clock or having to eat at noon time is a problem, but for me that’s not as big a problem as being triggered by negative feelings. It’s not that people eat so much when they’re not hungry because it’s time to eat, it’s that people eat when they’re not hungry because they’re driven to eat in order to cover up some negative feeling.

People have negative feelings all the time, all times of day and night, and in between etc., so that what drives people to the cupboard, or to the refrigerator, or the pantry on a regular basis is feeling lonely, feeling bored, or feeling depressed, or feeling unloved–so that’s the way they handle it. It’s the way they handle negative feelings, so I agree with you.

For me, we don’t even talk about weight, we just talk about can you stop eating, getting you to stop eating except when you’re hungry, and stop when you’re full. And if you do that and if you eat relatively healthy food and get some modicum of exercise, you’ll be fine. But for me the problem is eating when you’re not hungry because there is an emotional need.

Mr. Boyd: We’re pretty much on the same page with that. I probably am going to play up the healthy eating and treating yourself to proper nutrition and I am probably going to play down the negative emotions that you might be feeling that trigger it, but other than that I mean our outcome is the same.

Morty: How do you work with people? Do they just call you for a session and how many sessions does it normally take to get somebody to stop eating emotionally and start eating only when they’re hungry?

Mr. Boyd: Well, for most issues I’ve never been into this for long-term therapy. I would normally see a client for weight management probably three times with the initial session being pretty long because I need to learn quite a bit about how they approach the world and what talents they already have for dealing with things. Then usually a couple of weeks later we do reinforcement and then probably 3 months later. Usually, with weight management clients probably 3 sessions over the period of about three and a half to four months.

Morty: Okay.

Mr. Boyd: With most issues, I believe that change happens in a instant. Smoking for instance, I ordinarily see a client twice. Preparation for surgery, once. Now the only thing that is sort of ongoing would be hypnotic preparation for natural childbirth because I won’t be in the delivery room there so it’s necessary for me to teach the client self-hypnosis and to train their coach or partner in helping them deepen their trance.

So I probably see them half a dozen times starting their third trimester up until the birthday but the therapy can work, it’s not magic. It can seem like that sometimes because the power of the unconscious mind, but ordinarily it is short lived, the therapeutic setting.

Morty: That’s amazing to be able to produce that kind of result in a such a short period of time. And you find that hypnosis, I mean I’ve heard that some people are good hypnotic subjects and some people are not. Is that accurate or is everybody a good hypnotic subject?

Mr. Boyd: Everybody is different. The way they come up with the statistics is they’ll fit a hundred college students in a room and deliver a general hypnotic induction to the whole group or something like a systematic relaxation which works on about 80% of the people and that’s how they come up with their statistic, but I have yet to find out anybody that couldn’t do it. It’s just a matter of how a person would prefer to do it. Everybody can do it, it’s just people do it in different ways. I’ve had clients that giggle their way into trance.

Morty: [Laughs]

Mr. Boyd: Everybody does it differently but everybody can do it. It’s not something that’s strange or weird. It’s something that we all do all the time. People go in and out of trances in different times everyday. It’s not something mystical. It’s a function of the unconscious mind that happens all the time.

Morty: So basically you contend that if you’re working with an individual and you can work with them the way their mind works, you can get anybody into a trance that would enable them to resolve an overeating problem.

Mr. Boyd: Yes.

Morty: That’s exciting. Well, congratulations on that.

Mr. Boyd: It is indeed. I love what I do.

Morty: Most of the people that I’ve read about and have talked to basically say it’s an X number of weeks program or an X number of months program.  In our case I would say maybe 5 to 8 one-hour sessions, but to be able to do that in 1 or 2 sessions where they supplement an hour or a couple of months later is amazing, so congratulations.

Mr. Boyd: Well, you’re releasing belief systems.

Morty: We’re doing two things, releasing beliefs but also deconditioning triggers. Basically we would say that there is a conditioned response. Just like if you hear a gunshot, there can be a conditioned emotional response, like with PSTD. You can have an automatic response of dropping to the ground or something like that. If every time you have a negative feeling, you just happen to be eating because you eat three times a day, and you notice that there is a kind of a pleasurable distraction. Instead of feeling some negative feeling, you’re feeling good because you’re eating some tasty food. Number 1–it’s pleasurable. Number 2–it’s a distraction.

While you’re eating, you’re not thinking about your boredom or feeling unloved or your anxiety.  What people get is there is a positive reinforcement to eating and if you do that five times, ten times, or twenty times–at some point, it gets literally conditioned so that when you have any of these negative feelings, you just feel the desire to eat.

So what we do is we have a process that deconditions and it only takes about 10 minutes, but it actually deconditions each one of those because each one is conditioned separately. Boredom is conditioned separately from feeling unloveable, which is conditioned separately from general anxiety, which is conditioned separately from anger, etc.

We have found about 20 different conditionings, 20 different triggers so the first thing you do is to decondition each of the triggers and then you say, “Do you have any beliefs?” In many household, beliefs can be based on parents who were always on a diet, or say you have to clean your plate whether you’re hungry or not, or you were in a big family where there wasn’t enough food, so if you didn’t get it right away and you waited until the end, there wouldn’t be any food left. So there’s a whole bunch of situations, things your parents might have said or done around food that would result in you having several beliefs around food too.

Mr. Boyd: Right.

Morty: And what we’ve concluded is that if you decondition all the triggers and then eliminate all the beliefs, the emotional eating just stops. There’s no situation where, “Oh I feel like eating now.” You just eat when you’re hungry and that’s pretty much it, but that takes as I say, depending on a person, from 4 to 7 one-hour sessions and then yours is even faster. I thought ours was the fastest I know about but yours is even faster. I think everybody ought to–all of our listeners ought to know about this. Could you say where people could get in touch with you?  Give them a website where they can check you out.

Mr. Boyd: I have one that’s under construction. It’s not really ready to go yet.

Morty: But if you have a phone number. If any of the people listening on my list are interested in contacting you, what would be the best way to contact you?

Mr. Boyd: My phone number is area code 513-200-5720.

Morty: So that’s 513-200-5720 and it’s Estil Boyd.

Mr. Boyd: E-S-T-I-L.

Morty: Estil Boyd, yes. And you’re in Ohio, right?

Mr. Boyd: I see in clients in the Oxford, Ohio area. Yes.

Morty: Are people able to work with you on the telephone?

Mr. Boyd: I’ve never done that. No, I don’t think that would work very well because I–

Morty: Okay.

Mr. Boyd: I need to see responses. One definition of hypnosis is a listening unconscious responses so I need to be able to see that.

Morty: Well, you can see that on Skype which we didn’t have set up today but it costs nothing at all. If you have a computer, you can buy a webcam for $10 and download Skype for free and make as many calls. So basically we work with people in 60 different countries around the world and use the telephone or Skype. Our work is amenable to telephone work but it’s nice to be able to see people so almost all the time now, people are calling in from all over the world on Skype.

So you’re sort of limited, I mean we have people from 60 countries on our mailing list and from all over the United States so the possibility of anybody happening to be near Oxford, Ohio is pretty slim. I mean, maybe there is somebody there but there are probably lots of people from all over the world who might be interested in pursuing this. You might want to consider getting a webcam as I say it’s only about $10-15 for a workable webcam and they’re very easy to set up and if that would enable you to work with people outside of your area, that would open up the entire world for you.

Mr. Boyd: Yes, it’s certainly worth considering. I keep up with all the new things in hypnotherapy but I’ve got to admit I am sort of a technology dinosaur, but there are young people around me I can always ask for help.

Morty: As I said, I’ve given people your phone number 513-200-5720 so if any of you are reading a transcript of this interview or listening to the interview want to call, please call and maybe you’ll convince Estil to hire some local high school or college kid and set Skype up for him because as I say, it costs nothing. It does require no technical skills at all. You just click on the Skype button and then you click on the name of the person you’re trying to call and if you’ve got the webcam attached, they will see you and you will see them.

Mr. Boyd: Okay. Well I’ll look into it, Morty, and thank you very much for your time.

Morty: Well, thank you very much. I appreciate the feedback, it’s great. I am always interested in learning myself about more approaches to helping people with such a widespread problem and it seem to be growing both in the U.S. and around the world. There’s literally tens of millions of people with emotional eating problems and the result of the emotional eating and the weight is significant health problems. It’s wonderful that there are more and more approaches to dealing with it and I thank you so much for your time and as soon as we get this thing up I’ll let you know about it, but we should be able to get this out to everybody some time early next week.

Mr. Boyd: Great. Thank you very much, Morty. Have a great time the rest of your day.

Morty: You too. Take care. Bye-bye.

Mr. Boyd: Bye-bye.