Lapse Prevention & Eating Disorders

This section is about re-educating your reaction to a relapse, a set back, a 'bad' food day, or an inability to deal effectively with a trigger situation. A lapse is in fact highly motivational , as it gives you the opportunity to learn something else that is necessary on your journey towards weight loss.

Weight loss entails developing an ability to manage and learn from lapses hence their number reduces over time.

Where there is a lapse , there invariably is the introduction if the ''I've blown it syndrome.''
You know the drill…
You have had a really great food and mood day, you are just relaxing and you decide to have one biscuit or a few crisps and then just as you finish savouring the moment que… I've blown it now…. No point in this…. I might as well start again tomorrow or after the weekend… You then proceed to empty the contents of your fridge as you imagine the onslaught of the next attempt at losing weight…. Yea… we have all been there…

So how do you deal with the lapse that is going to happen as this is where the learning is laid down?

The plateau hits everybody trying to lose weight at some stage of their journey. Usually around the 4th week and if you were quite heavy to begin with, around the 8th or 9th week.
The plateau can last anywhere from one to three weeks, and unless you are very resilient, this is undoubtedly one of the main causes of lapses or set backs. Usually you feel you have been working so hard, there does not seem to be any change in your weight or body image and you feel hard done by. Before you know it you are climbing back into the fridge as disheartened as ever. If you deal with the lapse or stress that the plateau has caused, the you will not need food to anaesthetise yourself with.

Although there may not be a lot happening outside your body, there is in fact a whole lot going on inside your body. This is very crucial to weight loss and your future shape ! Suddenly the plateau will end and you may be down 3lbs in one week. You may then feel a surge of energy and you will then realise what the plateau was all about.

To deal with lapses more effectively you need to address the following….

First -you must view this lapse or set back, whatever you want to call it, as a vital learning experience in your weight loss process.

Each day needs to be viewed as a learning experience when you are recovering, regardless of what happens during the day.

Second - it is a good idea to see the lapse as an even better opportunity to learn something else about yourself.
How lucky are you to be able to have these opportunities when so many are still unaware of themselves !

Third -you then track your ''learning experiences'' and
Try and elicit a pattern… or possible triggers….
Did you eat little and often, was your blood sugar balanced ?
Did you get anxious about an upcoming event and turn to food ?
Did you starve thinking your body wouldn't realise it ?
Did you think the 'I've blown it syndrome' for no reason ?
Did you sabotage your efforts purposely or did someone else try ?

There are so many triggers and possible causes, however trying to ascertain a pattern will point to the culprit. Needless to say then you need to challenge the reasons as if they are consistently happening then you are missing out on a vital learning that is being presented to you through these learning experiences.

Fourth - you then need to anticipate and problem solve for the next episode. Have a scenario ready so you can reduce the 'I've blown it syndrome''.

It's not what we do, but the reaction to what we do that ends up causing more anxiety in the end.

Fifth - view each learning experience as a single event in other words live without reference to the past. Do not carry the baggage of the previous situation into the current one.
See it as being the situation that caused the problem not you . Now you have learned another coping skill to add to your repertoire !
If you think it is your fault, you are setting yourself up for failure and judging yourself unfairly and worse still, missing the learning.

Sixth - calm brings clarity and a real ability to see the situation for what it is and not how you are. ! By this I mean you need to step back in order to get the learning or else you are so immersed in it you panic, miss the learning ,(sure way to create the next episode) and you feel worse about yourself. This reduces the I've blown it syndrome and you can then look at it with new wisdom and not old conditioned responses.

Seventh - reaffirm your commitment to your weight loss process and acknowledge the path will be paved with learning experiences disguised as obstacles or lapses. It's up to you how you want to view them. Out of all difficulty comes opportunity…

Relapse Prevention

Recovery from an eating disorder is paved with lapses as they are in fact highly motivational !
It is imperative to educate the client about lapses in order that they can change or reinterpret their ‘reaction’ to a lapse as
Lapses can result in what I call the ‘’I’ve blown it syndrome’’ !

Re-educating the client about lapses helps the client to become aware of…
Details of triggers and patterns that went before lapse
Details of foods that were eaten, how and why
Details of how the lapse was dealt with afterwards… (I’ve blown it syndrome).

The therapist needs to be clear about the difference between a lapse, a relapse and collapse….
A Lapse is a single violation of a rule, use of a forbidden food, or performance of a forbidden behaviour
A Relapse is when 2 or more lapses are strung together
A collapse is a complete breakdown of rule system

Example Lapse – I’ll have one piece of chocolate and keep the rest for later
Example Relapse – I eat the whole bar so I may as well have the piece of cake I fancied to
Example Collapse – I’ve blown it, I may as well eat anything that isn’t nailed down, this isn’t working… I’ll start again Monday!

The above model applies to any habitual or addictive process including eating, drugs, alcohol abuse, gambling etc.
Teaching the client the following map helps them develop skills of changing the flow of their behaviour
Gaining control over the ‘I’ve blown it response’ will affect maintenance, motivation and commitment to empowered behavioural patterns.

Lapse Management Treatment Goals

1. Prevent and Reframe – make the person aware of their own triggers, patterns and set up’s, so they can see lapses don’t ‘just happen’ they are created
Help the client become an environmental
planner not a victim to the environment
(PREVENT WHAT WENT BEFORE LAPSE)

2. Change the Lapse Ritual , by this I mean change what happens ….
eat a bit slower
eat different foods in a different place
incorporate a new attitude
incorporate a new behaviour to undo trance element of behaviour
(CHANGE WHAT HAPPENS DURING LAPSE)

3. Develop Recovery strategies by eliciting cognitive techniques of Relapse Prevention
The ability to learn, reframe, and recover from lapses is a marker of future eating health
(CHANGE WHAT FOLLOWS AFTER LAPSE)

THE LAPSE MAP ….

1. Rules – Should’s / Shouldn’t / Willpower plus
Motivation – positive mental attitude / trust in rules / self belief / self efficacy

2. Trigger Situation – person / food / crisis situation / media image / weak spot

3. Conflict – discomfort / anxiety / confusion

4. No Lapse – Motivation is high /client using learned skills = Goal Achieved =Success !

OR ALTERNATIVELY

5. Denial – one won’t hurt / I deserve it / I’ll just have it this one time etc…

6. Lapse – Negative self talk / I shouldn’t /
Distress / Discomfort / Sense of self efficacy fails / I’ve Blown it effect
(if the lapse is seen as outside influence or a single event where skills have not been learned then little damage can be done. If lapse is seen as internal then self blame, judgements, and failure is perceived.

7.Self Efficacy (sense of being able to do it) is destroyed due to attitude

8. Motivation collapses – control abandoned

9. After a period of time…
10. Return to Rules & Motivation again !

Lapse Prevention Interventions

Again lapse prevention involves…

Prevent and Reframe (before)

Change the Ritual (during)

Recovery Strategies (after)

 

Lapse Prevention – PREVENT & REFRAME

1.Relax the Rules – should’s / shouldn’ts /musts / mustn’t / never …. The stricter the rules the greater the inner tendency to rebel ! Rules place the client in high risk situations. Abolish all/nothing thoughts.

2.Plan ahead – planning is the key to weight and food control – food diaries identify triggers and patterns to plan ahead for

3. Recognise set up’s and triggers – they can come in the form of…
urges and cravings
clothes shopping
media images
situations etc.
Learn Planning and Stimulus Control Skills

A craving is a overpowering desire for something that the client is conferring a temporary gratification. It may suggest to the client a loss of willpower and can be triggered by an idea, a smell, sights or can arise when the mood is low. Cravings also occur when deprivation real or imagined is felt ie hunger or low blood sugar

Cravings can also be viewed as an attempt to cope with internal or external source of stress, unrecognised anger, frustration, wanting, or a spiritual void. When the craving is satisfied then there is an immediate drop in tension and a surge of power, hence the addictive craving/gratification cycle

Educate the client that Urges and Cravings build to a peak and then subside if not gratified.
The more they are not satisfied the weaker they become.
This is true especially for sugar and choc, however this is easier said than done !

Some techniques to deal with cravings –
Stop /Look / Listen = Dissociate
This helps master cravings and deal with what is really going on
Calm down - relaxation skills are essential to learn for dealing with urges
Future pace how great you will feel if you don’t give into the urge and anchor the feeling.

Lapse Prevention – CHANGING THE RITUAL

Simple behavioural techniques such as slowing down when eating, changing what you eat, changing where you eat or the way you eat can assist the client in changing the trance element of the ritual, thus bringing a change of awareness around ritual and automatic behavioural chains

Lapse Prevention – RECOVERY MASTERY

Recovery mastery is the emotional and behavioural outcome of the ability to view lapses as LEARNING EXPERIENCES and thus reduce the I’ve Blown It Effect !
A strong sense of failure and powerlessness predicts a lapse will turn into a relapse or collapse of coping skills.

A Positive Attitude towards a mistake predicts (learning theory) , decreases lapse experiences and reduces the intensity of the lapse experiences.

Strategies include….
Reducing the I’ve Blown It effect
View Lapse as Learning Experience
- write LE on diary when lapse happens
- Explore what led up to lapse
- Problem solve for next time future pace

Attribute lapse as a single event and attribute to an outside influence ie high risk situation
Enhance Motivation by…
- Calming Down
- Relaxation Skills
- Self Care.

Lapse Prevention - SUMMARY

1. Manage Stress
2. Manage the IBI effect – not try to be ‘good’
3. Manage the Environment
4. Positive Self Talk
5. Planning Skills
6. Problem Solving Skills
7. Stimulus Control Skills.
   
   

Suzanne Horgan
director & founder
Certified Trainer in Practitioner Skills for Eating Disorders and Obesity

Contact Us today..........info@eatingdisorders.ie

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