The Role of Cognitive Behavior Therapy-Based Treatment

A volcano may appear dormant, but underneath, seething scorching lava waits to erupt. Often, a distressing life situation causes an overstock of energy to accumulate within a human being. In a very basic, instinctual way, the boiling energy wants to find expression in fighting, fleeing, or engaging in some other activity to “let off steam.”

Displacement behavior can also fill the role of stress reducer. When a person’s preferred form of displacement behavior is overeating, the results can be dismal and long-lasting.

Dr. Pretlow asks, “Can the displacement mechanism serve as a basis for a weight-loss intervention?”

As we see in the illustration from Slide 25 of his presentation, “Food/Eating Addiction and the Displacement Mechanism,” the feeding drive is one way to ameliorate — at least temporarily — the distress factor of situations with no good prognosis. He says of the displacement mechanism,

It is thought to involve opposing drives, for example, the fight versus the flight drive in the brain… And it is thought to re-channel to another drive, whatever drive is readily available, for example, the feeding drive.

Among the drives that are readily available, might there be such a thing as the not-feeding drive? Maybe it can be cultivated in people, especially the young ones before they become set in their ways. It can help them direct their energy, even the negative energy, into positivity. Maybe awakening the not-feeding drive is the secret of why some treatment modalities can work.

In the recently published article by Dr. Pretlow and three co-authors in the journal Eating and Weight Disorders — Studies on Anorexia, Bulimia and Obesity, we see a very encouraging message. When children and teenagers used their pent-up energy to follow Dr. Pretlow’s staged withdrawal method, they lost weight. More importantly, followup at five months showed that they maintained overall weight loss.

Dr Pretlow and his co-authors, Carol M. Stock, Leigh Roeger and Stephen Allison, draw the distinction between food addiction and eating addiction, and point out that in either case, not much effort has been made to test interventions. They suggest that cognitive behavioral therapy “has the potential to improve motivation, emotional regulation, coping strategies, and relapse prevention among patients with addiction, and go on to say,

Our research has focused on CBT-based treatment for E[ating] A[ddiction], which we conceptualize as having sensory and motor components.

The study described here also concludes that for young people, the effectiveness of staged food withdrawal is increased by the addition of therapies based on cognitive behavioral therapy, and designed to deal with Body Focused Repetitive Behaviors.

Your responses and feedback are welcome!

Source: “Treatment of the sensory and motor components of urges to eat (eating addiction?): a mobile-health pilot study for obesity in young people,” Springer.com, 01/14/20
Image: Weigh2Rock

Tapping the Source of Malaise

We have been discussing Dr. Pretlow’s presentation, “Food/Eating Addiction and Displacement Theory,” which can be accessed by clicking on the first item under “Presentations” on this page. It mentions quite a number of ideas that are worth pondering. For instance, Dr. Pretlow discusses a classic case of humans in an intolerable situation, grasping for relief.

During the Vietnam war, for military personnel on the ground, the experience was unbearable, yet they had no choice other than to bear it. The only ways out were to be killed, commit suicide, be grievously wounded on purpose, or quit. Desertion could lead to years in a military prison, and in fact desertion in wartime can incur the death penalty. There were, in short, no good choices. The displacement activity of heroin use was available, and many fell prey to it.

An addict is thought to be unable to get along without the drug of choice. Yet 90% of the supposedly addicted soldiers who returned to the United States never used heroin again. What does that mean? Dr. Pretlow says,

This pretty much conclusively shows that it’s not the substance that causes the addiction — for example the drug; or in the case of overeating, the junk food. It’s rather the life situation or the life events that cause the addiction. So, what are the implications of this displacement mechanism construct for obesity treatment?

Theoretically, if the individual can deal with the source of the aggravation and frustration, the displacement mechanism should stop on its own, without struggle and without the application of willpower, which is not in plentiful supply anyway. To halt the displacement mechanism, for instance the overeating, is is to stifle a symptom.

The underlying problem is still there. It might be a single factor, or multiple background sources in an accumulation of stresses. What we need to do, Dr. Pretlow says, is to “Help the brain stop the overflow energy production that fires the displacement mechanism.”

Carly

The presentation includes video of a young woman talking about her experiences. The worst problem was her horrible boss. Now, imagine being a teenager with a job so stressful, you spend your breaks running out to your car to eat junk food.

Imagine being that teenager’s employer, who might think anything from “She’s tracking so much dirt in from the parking lot,” to “She’s out there in her car getting high.” In other words, whatever reasons, legitimate or not, that the boss might have for acting angry or punitive — this displacement activity of overeating only makes it worse.

And when things are worse, the need for relief, via some displacement behavior, increases. We are now in a vicious cycle, or circle. So the employee feels more stress, and the boss becomes more abusive, etc., until somebody quits or gets fired.

Now, pause to imagine being a working teen. All the voices sing in tune: “You can’t quit your first job! It will go on your record forever! You’re lucky to even have a job! What if you can’t find another one? You’ll lose your car! Don’t you know how many kids want jobs and can’t find them? You should be grateful! Now you know what the real world is like, you want to go back to being a freeloader? Everybody has to learn how to get along with their boss,” and on and on.

Carly made a list of life problems, along with positive steps that could lead to resolving those difficulties — an action plan. There was never any question that the work situation was the biggest problem. But taking this analytic approach allowed her to see a path ahead, and understand that there were ways to cancel out whatever damage would be caused by quitting the job. Things worked out, and her compulsive eating problem faded away.

Your responses and feedback are welcome!

Image source: Dropbox

The Tricky Mind

This post continues the discussion of Dr. Pretlow’s conference presentation titled “Food/Eating Addiction and Displacement Theory.” Dr. Pretlow asks, what causes addiction, especially the non-chemical kind? This involves an examination of displacement behaviors, which many animals engage in when faced with a conflict between possible courses of action.

As Childhood Obesity News readers have seen, along with “fight or flight,” scientists have definitively or tentatively identified several other responses that answer to the description of displacement behaviors. In humans, even laughter has been implicated as a behavior that can serve to avoid trouble. It often works for children, who can deflect the anger of a parent by doing something funny. Sometimes, it even works at school, to stave off bullying. Sometimes it backfires.

Tooth and claw

Animals in raw nature have few options. They can fight, flee, freeze, or do a couple of other things. One of these is feed. It’s like a last-ditch distraction, perhaps to forget about imminent death. Maybe it can fool a predator into losing interest and moving on to another victim. Or to demonstrate, “I’m so nonchalant, how could you possibly be worried about a threat from me?” If millions of years of evolution suggest to an animal that eating is a viable defense, there must be some reason to it.

And we are not only talking about animals in savage nature. Pet dogs, cats, and even horses are notorious for being fat. Who knows what kind of problem brings this up? Maybe the couch looks so comfy, the desire to sleep on it is almost overwhelming. On the other hand, the human who owns the place will be displeased. Now, in what should be a peaceful life, a terrible conflict is raging. Dr. Pretlow says,

Destructive displacement behavior can also involve overeating in animals, where the animal is using feeding as a way of displacing a situation that they can’t readily face or avoid.

What happens to humans when the threatening enemy is not an animal or even another person, but one’s very own thoughts and feelings? The feeding drive comes in handy here. Without the exertion and inconvenience of fighting or fleeing, a person can temporarily assuage painful emotions by drowning them in food.

Hey, this works!

When that “stuffing” method proves to be successful, the subconscious mind gloms onto it and files it away. The memory of “food = happiness” is ready to resurface whenever a distressing situation occurs.

“Hey, remember that time when your feelings were hurt, and that hot-fudge sundae made it all better?” This kind of trigger is bad enough, and everyday life is certainly generous about presenting us with distressing situations that the brain can trick us into believing need to be fixed by eating.

But it gets worse. According to some kind of weird reciprocal mental construct, the sight or smell, or even the thought of food, can itself become a trigger!

The person sees a picture of a hot fudge sundae, and pulls up the sense memory. “Remember when you felt real bad that time, and you ate a sundae, and all the bad feelings went away? Well… surely there is something you are unhappy about right now. Just think about it for a minute. Something is bugging you, right? Well, today is your lucky day, because there just happens to be a hot fudge sundae waiting for you on the other side of this window!”

Your responses and feedback are welcome!

Image by Tommaso Meli/Attribution 2.0 Generic (CC BY 2.0)

Unable to Say No

If food is supposed to make people feel better, binge eating is a really bad investment, because 95% of binge eaters subsequently experience guilt, regret, and self-targeting anger. Picture a restaurant where 95% of the customers leave feeling worse than when they arrived. The venue would go out of business in a day.

This post follows from the previous one, continuing the discussion of Dr. Pretlow’s conference presentation titled “Food/Eating Addiction and Displacement Theory.” Numerous children have described the pattern to him:

• Step 1 — Feel bad.
• Step 2 — In a misguided attempt to feel better, eat helplessly, as if compelled by an exterior and irresistible force.
• Step 3 — Feel bad, only now with more justification.

As if that were not disturbing enough, additional complications are in store. That little program turns into a loop, and a spiraling one, at that. It becomes a vicious cycle, or vicious circle, or an infinity symbol, or a Mobius strip, or a snake swallowing its own tail. A lot of powerful symbolism is piled up behind the concept that our fates are sealed, and we cannot be otherwise than what we are. But we do not have to accept obesity as inevitable. Life is change — change that can be steered and shaped by humans.

How do we know this? Because there are also immensely complicated models like fractal designs. They are not captured in redundant, ever-repeating cycles, but are free to branch out in every direction, reaching for the edge of the galaxy. Every connection is a point on an individual path.

Making a turn

So, how does a person exit from a potentially destructive path and onto a more promising one? By realizing that out-of-context behavior is a danger signal. Eating when not hungry (and already overweight) is an example of inappropriate behavior that is not ruled by reason. Another red flag is out-of-control behavior that brings negative consequences, yet cannot be voluntarily controlled.

These are signs of addiction, and we are not just talking about the chemical kind like nicotine addiction, but the more nebulous and mysterious varieties, like gambling addiction. Obesity shows strong indications of being an addiction.

But knowing that is not enough. Dr. Pretlow asks, what causes addiction, especially the non-chemical kind? This leads to an examination of canine life. Dogs do a lot of different things, in the normal course of events, but doing those things under inappropriate circumstances, when they don’t make sense, is a danger signal.

For a dog to lick its paws is perfectly normal, but a dog who is in distress or socially isolated might lick right down the the bare skin, and then some. A cat will over-groom too, exposing hairless and irritated skin to infection. A dog expert, the narrator of a video clip included in the presentation, says,

What makes them displacement behaviors is when they happen, when they are displaced out of the context where you expect to see them. Displacement behaviors occur when the dog is in conflict about something, and experiencing stress about the conflict. A dog may be frustrated because he wants something he cannot get, or when he is experiencing conflicting motivations.

Other examples from the animal kingdom are given. Turkeys who perceive an existential threat will eat, just for something to do, even if they had dinner moments before and could not possibly be in actual need of sustenance. It’s a good way to break up two turkeys who are gearing up for a fight, but not for long. After they munch some grain to obtain anxiety relief, the hostilities will resume.

Your responses and feedback are welcome!

Images (from left to right) by Aine, Kent Schimke, Paul Albertella/Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

Sometimes We Can Only Ask, What Was I Thinking?

This post continues from the previous one, where sensory addiction was mentioned. Many foods taste delicious, and people lose their ability to abstain, or even to moderate their intake. They eat a lot of delicious food, and don’t burn off the calories, and become overweight to varying degrees, including obese, and sometimes Class 3, or what used to be called morbidly obese. Case closed.

If only life were so simple. The effect of sugar on the brain is a thing, but it’s not the only thing. Clearly, the sensory impact of sweetness on the taste buds is a thing, but it’s not the only thing either. Slide 7 of “Food/Eating Addiction and Displacement Theory” brings up the concept of motor addiction.

Many parents have experienced a sight that causes the heart to sink — the vision of a loved one mesmerized by a TV screen, cradling a bag or bowl of chips, and engaging in the eerily automatic, robotic task of conveying bits of food from bowl to mouth in a repetitive and mechanical way. We say “loved one” because it could be a spouse, a grandparent, or a child. Eating mindlessly, with the efficiency of a factory conveyor belt, is the kind of habit that is so easily caught, it spreads through a family like wildfire.

It might as well be hereditary

That particular repetitive behavior is called hand-to-mouth motion, and there are many others that incorporate the same trancelike absorption. Biting, chewing, gnawing, crunching, sucking, licking, and swallowing share the capacity for ushering a person into a mental state that may be vacant, while the body performs the same motion repeatedly, like a short snippet of videotape edited into a loop.

Needless to say, such heedless movements can lead to the ingestion of many hundreds of calories at one sitting. But that is not all. These repetitive acts, that sooth and somehow release a person from anxiety for minutes at a time, are similar to actions that psychologists call Body Focused Repetitive Behaviors. Some of these are disfiguring and destructive, while others are merely annoying to bystanders. They include nail biting, skin picking, hair pulling, and an assortment of “nervous tics.”

Somewhere in this great land there is a woman who got a divorce because she could no longer stand to see her husband stroke his beard. Somewhere there is a man who left his wife because she could not stop uttering a weird laugh after every sentence. The repetitive behaviors that keep people stuffing their faces work the same way.

Despite the alleged addictive qualities of various foods something else is going on. Dr. Pretlow says,

In our studies, upwards of 85% of the participants report that when they overeat, they overeat on whatever is available, not some specific, hyperpalatable food.

Over the years, Weigh2Rock has explored many questions by asking the visitors to respond to polls. One of these asked, “Do you think overeating is like nail biting?,” and as it turns out, more than half of the kids do think so. Segue into a related question: “Do you have bothersome urges to eat that you’d like to get rid of?” Almost 85% of the kids answered in the affirmative.

We have all heard of “buyer’s remorse.” The car that looked so great in the showroom is not really the treasure it seemed, and nothing can be done about it. Sorry! A similar emotion is “overeating regret,” the self-abnegation that can follow a food binge, or even a single dessert that turned out to be a lousy decision and proved out poor judgment once again.

Your responses and feedback are welcome!

Image by Melissa Gutierrez/Attribution-ShareAlike 2.0 Generic (CC BY-SA 2.0)

Roaring Into the Twenties

The journal Eating and Weight Disorders — Studies on Anorexia, Bulimia and Obesity has a long title, and with good reason. Obesity alone is a huge area to cover, and figuring out what is going on there becomes more crucial with every passing year.

Childhood obesity is at crisis level almost everywhere on earth, and every day the importance of stopping it early becomes more and more apparent. The urgency cannot be ignored, because with each year of age that a child adds the difficulty of treating the obesity seems to increase exponentially.

Some children apparently never have a chance, and seem to have been born doomed, because their antenatal environment irreparably impaired their ability to ever maintain a reasonable weight. This is why some researchers desperately seek answers in the womb.

Others have no choice but to try to mend the damage later. This journal comes at the problem from every direction: “anorexia nervosa, bulimia nervosa, subthreshold eating disorders, obesity, atypical patterns of eating behaviour and body weight regulation in clinical and non-clinical populations.”

The most recent issue contains an article whose title is also lengthy, “Treatment of the sensory and motor components of urges to eat (eating addiction?): a mobile-health pilot study for obesity in young people.” The authors are Dr. Pretlow and team members Carol M. Stock, Leigh Roeger, Stephen Allison.

A very hard nut to crack

Despite overwhelming suspicion and massive anecdotal reports from patients it has been very difficult to establish that any type of edible substance is addictive in the same way that, for example, nicotine and cocaine are addictive. While overeating as a substance addiction looks deceptively obvious, proof is elusive. Part of the confusion comes from the fact that individuals undeniably have “problem foods,” and subjugation to the power of certain particular problem foods is shared by huge numbers of people.

This paper examines the idea of eating addiction as a combination of sensory addiction and motor addiction. Dr. Pretlow has shown that staged food withdrawal can tame the sensory component. The motor addiction component concerns body-focused repetitive behaviors (BFRB), similar to nail biting, skin picking, and hair plucking.

Some people become dependent on the comfort afforded by the motions of biting, chewing, licking, crunching, sucking, swallowing, and hand-to-mouth motion. The team is optimistic about the idea that these “nervous” activities that people employ for the purpose of self-soothing can be treated with strategies based on cognitive behavioral therapy (CBT), which is successful in quelling other motor addictions.

Here is what happened:

Using staged withdrawal, participants withdrew from specific, self-identified, “problem” foods until cravings resolved; then from non-specific snacking; and lastly from excessive mealtime amounts. BFRB therapies utilized concurrently included: distractions, competing behaviors, triggers avoidance, relaxation methods, aversion techniques, and distress tolerance.

The results were better than those obtained from a previous study that only used staged withdrawal, and the participants maintained overall weight loss as documented by the five-month followup.

For children and teens, what we see here is increasing evidence for the acceptability and viability of an addiction model treatment of obesity. It begins to look as if CBT has the potential to not only improve motivation, but to boost emotional regulation, strengthen coping strategies, and stave off the likelihood of relapse.

Your responses and feedback are welcome!

Source: “Eating and Weight Disorders,” Springer.com, undated
Source: “Treatment of the sensory and motor components of urges to eat (eating addiction?): a mobile-health pilot study for obesity in young people,” Springer.com, 01/14/20
Image by Roderick Eime/Attribution-NoDerivs 2.0 Generic (CC BY-ND 2.0)