I began this series on how food anxieties are born and strengthened and addressed how your outlook on food could be cultivating these fears. For some, a little reassurance of the absurdity of certain attitudes towards food can go a long way to weaken these fears. For those lucky ones it’s enough to put them back on the path towards sensible moderation. Sadly, for others these fears are so deeply engrained that seeing past them is not as simple as knowing better. I experienced this first hand and know the exhausting emotional entanglement of understanding that my fears of food were considered irrational but still being unable to see past them in moments when they were accustomed to taking the wheel.
Again, I am not a doctor or eating disorder specialist and the information here is not to replace that of your doctor’s. Learning to overcome my various food anxieties was something that consumed my life for years as I fought to overcome an eating disorder by my own devices. Without going into too much detail, I was not in the position to receive any of the necessary in-patient treatment and had to overcome my struggles on my own. I was fortunate enough to have the support of an excellent psychiatrist but the majority of my recovery was done from home and was of my own design.
The initial phase of my ED recovery focused on getting my body to a healthy weight. This was the ‘easy’ part of the process. The issue of rehabilitating my mind was far more complex because no matter how much I tried to tell myself that all foods are ‘allowed’ meal time continued to be borderline traumatic as the intense fear to get away from the food I was trying to eat resurfaced each time. The fears I battled were born when I acquired a firm belief that certain foods would make me fat or sick. Even when I was at the point of accepting that such fears were unfounded my brain had not yet unlearned the subconscious response to the food: intense anxiety. It was very easy to feel trapped at that juncture and my sympathies go out to anyone facing these struggles today. I hope that my experiences can bring such individuals hope as I did eventually find my way out of the cycle and the way I got out was the way that I got in.
I had to unlearn what I had learned. Or some would say I had to teach my brain to elicit a different response to the foods I feared. As far as I know the underlying mechanisms are still up for debate…but tomato, to-maah-to. I had to get my brain to react differently to certain foods.
A common way of dealing with food anxieties is by avoiding the foods that trigger these uncomfortable urges and emotions. Individuals go to lengths to avoid the foods that make them feel uneasy. They keep them out of the house and make efforts to evade social situations where such foods are present. They throw out cookies that were baked by a friend. They walk with Tupperware to family get-togethers and choke people with the smell of steamed broccoli in the movie theater. They take on the role of the chef’s nightmare with highly specific modifications to menu items. (Mind you I have done all of these so I’m also making fun of myself) These are all extremes that are wholly unnecessary for anyone who isn’t a few weeks out from a bodybuilding show, photoshoot or weight specific competition. Not only do such habits heavily impact the quality of life of the individual and those around them but avoiding the foods that cause you anxiety is nothing but treating the symptom and not the cause. Eventually you will be faced with the foods that make you anxious (or foods that make you want to binge) and you may find yourself defenseless.
In my first write up of this series I explained that fear of food can be acquired when your perspective on the food changes. Once you learn to regard the food as harmful or ‘bad’ your brain learns to trigger a fear response when presented by that food. The simple conditioning model hypothesizes that fears are acquired by repeated presentations of a conditioned stimulus (CS) followed by a pain-producing or fear eliciting stimulus (unconditioned stimulus; US). [1,9] In my previous article I mentioned the Little Albert Experiment as an example of this type of conditioning. If you remember, they attempted to make an 11-month old baby ‘learn’ to be afraid of rats by banging a steel bar every time he reached out to touch a rat. In this case the rat is the CS and the banging of the bar is the US. Little Albert’s response to those rats soon shifted from automatic joy to automatic discomfort any time he was presented with one of them. [10] Following this model the food that you regard as ‘bad’ is the CS and the ensuing self-depreciating thoughts post-consumption could be a strong enough US. Now, when presented with that food your brain triggers a fear response in order to avoid this uncomfortable event or the imagined threat of sickness or fat gain. The brain triggers your fight or flight response in order to compel you to get away from this perceived threat and that compulsion leads you to feel anxious. This is your conditioned response.
The neo-conditioning model as well as the modern learning theory perspective suggest that fears can also be learned though verbal communication and even observation. These suggest that simply being told, or seeing someone exercise a need to avoid certain foods can be enough to learn that response yourself. The modern learning theory suggests that fears can also be conditioned through predicting the likelihood of stressful events (”The last time I ate this I felt so guilty…”). If the above is true we need to be selective with the information that we buy into and the kind of health and fitness personalities that we allow into our heads. Have you ever been happily going about your life doing something one way and after seeing someone you admire approach that same thing differently then begin to doubt yourself? Over the years I have encountered complaints like:
‘Fitness Guru A says she doesn’t eat any carbs unless she just did a workout because any carbs not consumed around training will be stored as fat. Now I don’t even feel good about eating fruit.’
‘Fitness Guru B says that he eats clean all year and that is why he doesn’t gain any fat. He says if I have excess bodyfat it is because I am not disciplined enough. Now I don’t know what is ok to eat and feel terrible when I have to eat out and there are no ‘clean’ options.’
‘How does Fitness Guru C eat so little? I’m starving and I eat twice that much but she says her portions are healthy. Now I feel guilty every time I eat.’
‘Fitness Guru D says that sugar will make me sick and give me cancer and if I eat it in any form then I don’t care about my body.’
These are examples of how certain types of inaccurate claims made by high profile ‘health’ personalities have altered an individual’s perspective and been damaging to their relationship with food.
If someone is trying to negatively reinforce your adherence to their approach by spouting threats about the evils and dangers of straying from their plan or consuming even small quantities of certain foods — just run.
You can safely eat a variety of foods in moderation, even foods with low nutritional value, and there is no evidence to suggest otherwise. So long as you are eating a good amount of wholesome foods regularly there is no reason to deprive yourself of the consumption of foods that you simply enjoy regardless of their nutrient and macronutrient profile. My last article on food anxiety discussed food moderation and can be found here.
Moving along, hopefully my very simplified explanation of how we can find ourselves in the cycle of food anxiety has shed a bit more light on why you may be feeling discomfort around food and how certain media influences can mess with your head. Knowing this is all well and good…but how does one get over these conditioned responses?
Fear extinction can come about when you learn to associate the CS with something that isn’t bad (guilt, fat gain, banging of steel bars etc) and the brain no longer feels the need to produce a fear response. This is why I feel that avoiding the food that you are nervous about is going to make it very difficult to overcome your conditioned anxiety.
I learned from my experience that instead of allowing myself to feel guilt after eating certain foods I had to eat those foods and learn to relax. I had to prove to myself that I could eat these things and nothing bad would happen. I had to do this and repeat this eat and relax cycle over and over again to reinforce the new pattern of reaction. This is essentially exposure therapy; a form of cognitive behavioural therapy (CBT). It’s defined as a form of ‘cognitive intervention that specifically changes the expectancy of harm.’ [1] In other words, it is way of training your brain to no longer regard the things you fear as something to be anxious about. From the perspective of basic conditioning it is known as ‘fear extinction training’. CBT is one of the leading treatments for eating disorders.[2] It’s proven effective in the treatments of anorexia, bulimia, binge eating disorder and eating disorders not otherwise specified. In the treatment of bulimia it demonstrated both short and long term improvements above that of what could be accomplished via medication! [3]
The rest of this article will outline the different ways I went about creating the environment for fear extinction using real-world scenarios and examples. Again, this is not to replace the advice of any professional that you may be working with but to simply share what proved effective for me when attempting to reduce my anxiety around eating and repair my relationship with food.
-An easy one to start with is to stay away from websites, fitness personalities/celebrities, magazines etc that help to reinforce your fears about eating certain foods.
You may not have to do this forever but until you are at the point where you have no doubts in your mind about your ability to ‘safely’ consume certain foods it is best to stay away from influences that will fan the flames of your uncertainty.
-Educate yourself on nutrition from unbiased sources with no wish to sell you anything like meal plans or services. Continuing in the vein of point one, being reassured by reputable sources that consuming previously feared foods is safe can potentially help decondition the fear [7] If you don’t want to do the research yourself, consider speaking with a registered dietician or nutritionist who specializes in eating disorders. I did not have access to a reputable RN but influences such as Alan Aragon, Lyle McDonald and later my husband Chester Rockwell served greatly to lessen my fears of sugar, carbohydrates and eating above 2000cals.
-Eat the foods that you are afraid of with friends that have a good relationship with food. When I was deep in my disordered eating I found myself wondering how I would ever be able to eat normally again. I truly felt as though I could not remember how and it was incredibly disheartening. My wonderful husband was a great influence for me here. Observing his healthy relationship with food and seeing his ability to be so objective about his food selection was helpful to me learning to let go of my fears.
You can re-learn ‘normal’ eating habits and soften your anxieties by observing the eating habits of others who are able to eat the foods that make you anxious with no reaction of fear. It’s been observed in nature as Mineka and his associates managed to demonstrate monkeys developing a fear of snakes by observing another monkey respond fearfully to them (snakes not other monkeys).[5] This may very well work in reverse and help you to lower your guard around foods that otherwise would make you nervous. Right in front of you will be living proof that it is possible to eat certain foods without guilt and that can be a powerful motivator and reassurance. It’s a social version of the type of exposure therapy done with the support of a therapist where patients are exposed to the ‘feared object’ in the absence of adverse consequences. [11] Except in this case, your friends and their lack of fear response can help create an environment for you too to learn to relax around foods that previously caused you discomfort.
Monkey see, monkey do.
-Portion out servings of ‘trigger foods’ beforehand.
This is especially helpful for anyone trying to overcome the fear of a food that makes them experience a loss of control that in the past has lead to a binge (trigger food). Allowing yourself a healthy portion of this food can help you to reclaim your feelings of control and also let go of your fear of being unable to eat the food in moderation. I did this with peanut butter (the food which triggered panic attacks just from holding the jar and later became something I would eat the entire jar in one sitting.) I would portion out a single 2 tbsp serving and then place it in the freezer during the day. At night, I would remove it from the freezer and let it thaw overnight. By morning it would be ready for me to portion out another 2 tbsp before popping it back into the freezer and heading out to work.
Disclaimer: Yes. I did creep into the kitchen in the middle of the night and manically stab the frozen brick of peanut butter with a kitchen knife in order to get an extra chunk a few times in the initial stages. That was a learning experience on it’s own because it made me very aware of my strange relationship with this food. Over time, catching myself in such behaviour brought me to a point of being able to laugh at it (‘Am I seriously stabbing PB right now?’), relax and put back the peanut butter OR consciously choose to do it anyways and shake off the occasional over-consumption.
Now the peanut butter remains unmolested in the cabinet and I am absolutely ‘take it or leave it’ about a food that once drove me into a frenzy.
-Avoid ‘damage control’
The anxiety following the consumption of certain foods or certain quantities of food can drive an individual to want to compensate for the ‘dirty’ calories or extra calories by any of the following:
-Restricting intake the following day
-Over exercising or increasing expenditure in order to burn the calories off
-Purging via laxatives or vomiting
-Any combination of the above.
This pattern of behaviour only reinforces the mentality that what you did was wrong and it will continue to keep the fear alive. Eating these foods will continue to prompt the brain to trigger anxiety when the threat of punishment is still present [9] Break this habit by learning to roll with the punches and avoid any kind of dietary manipulation as a result of eating the foods that make you anxious.
-Engage in relaxing or calming activities after eating foods that make you nervous.
Reduction of anxiety may serve powerfully to reinforce the behavior that brings about such a state of relief or security.[9] Again. This goes along with proving to your brain that the food is not truly a threat and will not result in guilt or punishment. Instead of allowing yourself to sit and feel anxious after consuming foods that you’re still a bit weary of consider new habits such as:
-Going for a light walk outside.
-Practicing deep breathing or meditation
-Listen to soothing music or calming, guided reflection
-Writing your thoughts down
Pick anything that you know will help you get closer to a state of calm. With repetition you may be able to associate that food with a feeling of calm as opposed to fear and guilt. It is worth noting that engaging in calming activities post-meal is an excellent coping mechanism for dealing with the psychological stress that can come about with facing trigger foods.
This has been a long one so thank you for sticking it out. I’ll end with an excerpt from Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010) which pretty much sums up all of the above:
‘’Patients are helped to recognize that their multiple extreme and rigid dietary rules impair their quality of life and are a central feature of the eating disorder…The first step in doing so is to identify the patient’s various dietary rules together with the beliefs that underlie them. The patient is then helped to break these rules to test the beliefs in question and to learn that the feared consequences that maintain the dietary rule (typically weight gain or binge eating) are not an inevitable result. With patients who binge eat, it is important to pay particular attention to “food avoidance” (the avoidance of specific foods) as this is a major contributory factor. These patients need to systematically re-introduce the avoided food into their diet.’’[2]
Though I do not believe that everyone with food anxieties has an eating disorder I do believe that having fear about food is a disordered way of thinking that needs to be addressed. Luckily for us, no matter how ingrained these fears may be they are not hardwired in a way that is forever unchangeable. If you’re struggling with fears about the way that certain foods will affect your health and your body you may want to reconsider your habits around eating the foods in question. Start small and try not to take on too many things at once. Consider making a list of all of the foods that you would like to make yourself more comfortable consuming and start from the ‘smallest’ offender and work your way up. There is nothing keeping you from your freedom from food anxiety other than persistence and time.
Previously in the Food Anxiety Series:
Food Anxiety: How the ‘Good Food/Bad Food’ Mentality Could Be Affecting Your Brain
Food Anxiety: Should I Eat This?
References:
[1]Hofmann SG. Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical psychology review. 2008;28(2):199-210. doi:10.1016/j.cpr.2007.04.009.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268629/
[2]Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America. 2010;33(3):611-627. doi:10.1016/j.psc.2010.04.004.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928448/
[3]Shapiro JR, Berkman ND, Brownley KA, Sedway JA, Lohr KN, Bulik CM. Bulimia nervosa treatment: a systematic review of randomized controlled trials. Int J Eat Disord. 2007 May;40(4):321-36.
https://www.ncbi.nlm.nih.gov/pubmed/17370288
[4] Phelps EA, O’Connor KJ, Gatenby JC, Gore JC, Grillon C, Davis M. Activation of the left amygdala to a cognitive representation of fear. Nat Neurosci. 2001
https://www.ncbi.nlm.nih.gov/pubmed/11276236
[5] Mineka S, Zinbarg R. A contemporary learning theory perspective on the etiology of anxiety disorders: it’s not what you thought it was. Am Psychol. 2006
https://www.ncbi.nlm.nih.gov/pubmed/16435973
[6] Kim, Jeansok J., and Min Whan Jung. “Neural Circuits and Mechanisms Involved in Pavlovian Fear Conditioning: A Critical Review.” Neuroscience and biobehavioral reviews 30.2 (2006): 188–202. PMC. Web. 16 May 2017.
[7] Phelps EA, O’Connor KJ, Gatenby JC, Gore JC, Grillon C, Davis M. Activation of the left amygdala to a cognitive representation of fear. Nat Neurosci. 2001
https://www.ncbi.nlm.nih.gov/pubmed/11276236
[8]Linardon J, Brennan L. The effects of cognitive-behavioral therapy for eating disorders on quality of life: A meta-analysis. Int J Eat Disord. 2017 Apr 21.
https://www.ncbi.nlm.nih.gov/pubmed/28430364
[9] Mowrer OH. Stimulus response theory of anxiety. Psychological Review. 1939
[10] CONDITIONED EMOTIONAL REACTIONS By John B. Watson and Rosalie Rayner(1920)
http://psychclassics.yorku.ca/Watson/emotion.htm
[11] Davis M, Ressler K, Rothbaum BO, Richardson R. Effects of D-cycloserine on extinction: translation from preclinical to clinical work. Biol Psychiatry. 2006
AddingPins' Blog