Monday, May 2, 2016

Benefits of Post-Meal Support Groups in an In-Patient Setting

By Hellen Cappo, LPC, LMFT
Post meal processing is an opportunity for individuals struggling with disordered eating to fully explore the myriad of cognitions and emotions (guilt, shame, anger, fear) that surface in response to nutritional restoration, which is a major goal of early treatment. During this active and experiential processing, patients are able to engage with faulty cognitions related to food, weight, and shape that influence disordered eating habits.  Irrational beliefs about nutrition lead to abnormal eating patterns and are part of the daily struggle for those active in their eating disorder. An advantage of post meal processing, is engaging with the clients’ mealtime experience as the obsessive rumination occurs.
The hours after meal times can produce additional urges for compensatory behaviors. Urges to: purge, exercise, self-harm, or other maladaptive behaviors are often identified by patients as they learn to sit with the emotional and physical discomfort that refeeding in an in-patient setting provokes. Post meal processing is a supportive avenue to promote the use of healthy distraction skills such as: coloring, reading, or listening to music. Encouraging patients to engage in sensory based actives like: using play doh, utilizing scented lotions, or progressive muscle relaxation, enables clients to stay mindful of their physical experience while trying to disengage from distorted beliefs about how their recent meal intake is affecting their weight and shape.
Post meal processing is also crucial after individual nutritional challenges such as incorporating “fear foods” into a patient’s meal plan or completing a food exposure. A dominant feature of Anorexia Nervosa is the severe restriction of food intake and variety. The ability to broaden a variety of food choices into one’s meal plan is a predictor of continued success post discharge from an in-patient treatment setting. For this reason, patients at all levels of Eating Disorder treatment engage in nutrition challenges which provide the opportunity for post-meal reflection on their perceived and actual accomplishments and resilience. Using post-meal processing to increase a patient’s positive view of their new eating habits can increase motivation and hopefulness about their ability to recover.
Group leaders, therapists, and nutritionists act as models for helping individuals relearn normalized, non-guilt inducing responses to eating by providing structure and guidelines for post-meal processing. Setting boundaries on the content of discussed information helps guide patients as they become proficient in distinguishing healthy thinking from distorted thinking. Reframing the meal experience helps patients identify methods used to eat through discomfort and to not focus on meals feeling uncomfortable.  Group leaders also help direct patients in learning how to normalize their discussions about eating by shifting content to focus on the patient’s communication of their meal experience: shying away from focus on negative judgments about food or distorted beliefs about how the meal impacts the patient’s weight or shape.
At The Eating Disorders Treatment Center at River Oaks Hospital, post-meal processing is held in a group format. Open forum allows patients the chance to explore cognitions and emotions triggered during meal time. With peer support, patients challenge Eating Disorder related experiences in the moment that they are occur. Post meal processing groups are led by trained staff members who promote open expression of emotions while encouraging reframing, skills use, and honesty of their intrapsychic experience. Staff members are available to provide structure and guidelines on content that promote a sense of safety for patients in which to honestly engage. Communication regarding the content of meals and post meal processing allows for deeper exploration of triggers or emotions in patients’ individual therapy sessions or during the daily therapeutic Process Group.

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