NEDAW and Grounding

Grounding Techniques to Build Internal Safety: 

Practical Tools to Manage Eating Disorder Behaviors Without Shame

This week (February 23-March 1) is National Eating Disorders Awareness Week, a campaign that happens each February to raise awareness of eating disorders, challenge stigma and provide hope for those struggling. This year’s theme is “Every Body Belongs.” Belonging requires a sense of safety- the feeling that you are free to bring your whole self and be accepted without judgment.  While it is so important to find and build such safe communities, for someone struggling with an eating disorder, it’s also a lack of internal safety that is driving their behaviors. Therefore, using internal resources to establish safety in one’s body is just as important as seeking safety externally through community. 

Understanding Eating Disorder Urges

Simply put, urges of any kind are nervous system responses. The stress cycle begins when an external trigger activates the nervous system and the brain responds with an urge. Urges are not personal failures and can be survival instincts such as the urge to flee a burning building helps you to escape danger and find safety. Hormones and neurotransmitters can amplify urges as can emotional states.

Why Eating Disorder Urges Feel So Strong

For someone struggling with an eating disorder, chances are extremely likely that at some point in their past their body stopped feeling safe to them. This could be due to unexpected weight gain or body changes, or it could be the result of sexual trauma, or some combination of the two. If someone doesn’t feel safe or content in their body, they are in a state of constant stress. How this plays out in the brain is that the amygdala sends a distress signal and the hypothalamus activates the sympathetic nervous system by sending signals to the adrenal glands. These glands pump epinephrine (adrenaline) into the bloodstream and prompt changes such as increased heart rate and blood pressure. The hypothalamus keeps the “foot on the gas pedal” and releases other stress hormones, including cortisol. This keeps someone in high alert and in “fight or flight” until the threat passes, and then the parasympathetic nervous system pumps the brakes to calm and regulate. The problem is for someone who is self-critical of their body, they are both the attacker and the attacked- prolonging the stress response. In addition, traumatic stress can cause chronic changes to the brain that increase release of cortisol and epinephrine which play a role in PTSD symptoms including flashbacks, hyperarousal, intrusive thoughts, and sleep and memory problems. Eating disorder behaviors often serve a function of attempting to regulate the stress response, which they may do temporarily but cause long-term harm. Therefore, urges may be particularly strong for someone with a history of trauma and negative body image because they are so often in a sympathetic state, and the behaviors such as restricting, bingeing and purging bring a false sense of control and relief.

Urges Are Temporary (Even When They Don’t Feel Like It)

While urges are a natural response, their intensity rises and falls. Therefore, practicing mindful awareness of urges without acting on them can give a person the opportunity to practice a healthy emotion regulation skill until the intensity of the urge falls. Using healthy coping skills does not eliminate urges, but it help to mediate them. Developing mindful awareness takes practice, and a good place to start is with grounding.

What Are Grounding Techniques?

Grounding is a set of present-moment techniques that engage the senses, breath, and body to reduce anxiety, panic, or dissociation. Therefore, they are helpful tools for anyone, not just those struggling with eating disorders. They help you to disconnect from distressing thoughts and reorient you to safety in the here-and-now. Some examples include:

1. Grounding with the senses by naming: 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell and 1 thing you can taste.

2. Intentional breathing:

a. Box breathing: Inhale to 4, hold for 4, exhale for 4, hold for 4

b. Extended exhale: Inhale to 4, hold for 7, exhale to 8

3. Body-based:

a. Press your feet firmly into the floor and notice the sensation. This is even better when done barefoot on the grass.

b. Hold something cold such as ice or a cold drink

c. Wrap up in a weighted blanket

How Grounding Helps with Eating Disorder Recovery

As explained above, urges to engage in eating disorder behaviors are often triggered by stress. Several of my clients have told me that engaging in a behavior felt like such an automatic response that not using a behavior didn’t feel like a choice. That neural pathway in their brain may have been repeated so many times that the rut was dug deep. The hopeful truth is that our brains have neuroplasticity- the ability to change and heal through new neural pathways. Grounding is the first step that interrupts the automatic nature of eating disorder behaviors. It’s like a Detour sign placed in the middle of your daily commute to work that forces you to slow down and pay more attention to the alternate route. Grounding doesn’t stop the urge but it creates a pause so that you have a greater sense of safety and choice.

When to Use Grounding Techniques for Eating Disorder Urges

“The sooner the better” is the rule that applies to increase the effectiveness of grounding techniques. Mental, emotional, and physical cues vary from person to person. It’s probably a good time to ground if:

· you notice yourself or someone you’re close to obsessing over a menu and unable to decide on what to choose.

· someone makes a rude or inappropriate comment about your body causing shame.

· you’re beginning to feel uncomfortably full after a meal.

· you’re in a situation that involves conflict or overwhelmed by too much responsibility.

When practicing a grounding technique, focus on regulation, not control. Getting into a battle of control, even in your mind, can make things worse.

Sensory Tools You Can Use Anywhere

Don’t make grounding too complicated. The best tools can involve simple objects, scents and sounds. For example, when you’re out for the day take a bag that includes a fidget toy or symbolic object such as a cross or a stone, a tiny bottle of essential oils or scented lotion, and ear buds to connect to soothing instrumental music or nature sounds on your phone. When eating, practice mindfulness of taste, texture, aroma and aesthetics. Slow your pace and breathe throughout the meal, letting go of food rules.  

Mental Grounding Techniques for Racing Thoughts and Food Fixation

When stuck in a mental loop and fixated on food, try some of these tools:

· Name objects around you by color or category

· Count backward by 3s or 7s

· Do a simple word or number game

· Write down the urge instead of acting on it

Grounding Statements to Use that Focus on Reality and Self-Compassion

Orienting to time and place can be helpful in connecting to the present moment. Honestly naming and validating your feelings decreases shame. Speaking compassionately to yourself in the way that you would speak to a good friend or young child can be grounding and comforting. Reinforcing agency and resilience can be helpful. Here are some examples:

· “It’s 3:00 on a Tuesday and I’m in my living room.”

· “Right now this feels uncomfortable but I’m safe, and this urge will pass.”

· “I’m feeling unsettled after that conflict and I need to be in a peaceful place.”

· “That was a really hard situation and I handled it the best that I could in the moment.”

· “It’s understandable that I would be having urges after such a stressful morning.”

· “I’ve been through a lot, and that has made me stronger.”

When Grounding Techniques Aren’t Enough

While grounding techniques can be very useful, they will not interrupt every urge. Especially if you have a history of trauma and/or eating disorder behaviors have been part of your way of coping for several months or years, you will need some extra support. Eating disorders are deceitful villains who can’t be taken down through a 1-1 battle. They require a team of trusted professionals and supportive people who have your back. The treatment team needs to be comprised of a therapist, dietitian, primary care provider and psychiatrist or psychiatric nurse practitioner. It’s also important to find a healing community where you feel safe to bring your whole self. This could be an eating disorder support group such as those offered locally through Renewed:  https://renewedsupport.org/programs/ (This site also provides referrals to eating disorder professionals.) Healing community could also come through a small group within your church or spiritual community. Regardless, it’s important to know that you deserve to feel a sense of belonging. Every Body Belongs in this world and each life has a purpose:

Sources:

NEDA Website: https://www.nationaleatingdisorders.org/nedaw/

https://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

https://pmc.ncbi.nlm.nih.gov/articles/PMC3181836/