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Clementine Briarcliff Manor Primary Therapist Dana Sedlak, LCSW discusses the progression of “emotion mind” to “wise mind” in eating disorder treatment. In this week’s blog post, Dana explains how our emotions are directly tied to our behaviors and some strategies used to support clients in recognizing and moving past maladpative behaviors.

One of the most difficult parts of treatment involves identifying and understanding one’s thoughts and feelings. This can be more challenging for those with eating disorders whose function has served as a numbing agent for several unwanted emotions. It has become natural and sometimes habitual to dismiss feelings in order to feel in control. Through DBT (Dialectical Behavior Therapy), teenagers are introduced to the idea of Distress Tolerance: Unfortunately, pain is a part of life and therefore one must learn how to manage difficult emotions.

Many teenagers speak to having an increase of emotions once they begin completing their meal plan in treatment. We often wonder whether they are experiencing more emotions due to many of their eating disorder behaviors decreasing or because they are becoming more connected to themselves and others due to the therapeutic process. Despite the reasoning behind this, the increase in emotions is extremely uncomfortable for them. They often report feeling easily overwhelmed by these emotions with little confidence in coping with them. The danger in this scenario is that without intervention, emotion mind leads right back to use of destructive behaviors. They then become stuck in what often feels like an endless cycle.

The beginning of this cycle includes a precipitating event that is identified as the trigger. This could be anything from a death of a loved one to getting a poor grade on a test. One’s emotions then start to bubble up, including depression, desperation, anxiety, and worthlessness. Shortly after these emotions then turn into thoughts that become fueled by these emotions. “I can’t deal with this anymore” and “I’m so dumb, I might as well just stop trying” are prime examples of these emotion-driven thoughts based on the triggering event. As we know from CBT (Cognitive Behavioral Therapy), the thoughts also quickly turn into behaviors. This is where one’s eating disorder and co-morbid illnesses take hold. Restricting, binging, purging, over-exercising, self-harming, and other similar behaviors serve as protective measures that protect one’s ego/self-esteem in order to avoid these thoughts and emotions.

Once the behaviors have initially subsided, consequences are likely to appear. This could occur in either the short or long-term, but often results in loss of freedom, relationship problems, health problems, or a worsening of symptoms. Emotion mind revs up and creates more feelings of depression, anxiety, being overwhelmed, and an increase in shame because of these consequences. These emotions now feel intolerable again and one resorts back to what she thinks works: Covering up these emotions through more behaviors.  Before she is even aware, she becomes stuck in this cycle of suffering all over again.

The goal through DBT is to intervene at the beginning stages of this destructive pattern. It is vital in recovery for one to be able to appropriately identify and feel one’s emotions. It makes sense for someone to feel sadness after a death or anxiety after doing poorly on a test. We never want to invalidate this part of the experience. What we would like to change comes in-between the negative thoughts and the behavior use. At this point in the cycle, one must learn to challenge her thoughts and then seek self-soothing coping behaviors to gain the same sense of protection and security that the eating disorder often creates. This can come in the form of one’s five senses of sight, sound, smell, touch, and taste. Go outside in nature, listen to your favorite song, smell a candle of a scent that brings you peace, take a warm bath or shower, or sip on your favorite drink.

Through continued intervention and practice, emotion mind will mold into wise mind where one no longer needs to use the eating disorder to manage and push away the emotions. Instead, one has gained the courage to face the emotions as they are. By breaking this cycle, one becomes vulnerable enough to know and believe that she is completely capable of working through any emotion that arises. It is then that one can begin to slowly and surely let go of the old destructive behaviors that no longer serve the same purpose.


References: “Out-of Control: A Dialectical Behavior Therapy (DBT)-Cognitive-Behavioral Therapy (CBT) Workbook for Getting Control of Our Emotions and Emotion-Driven Behavior”


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