SPT-Fall2014

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esponse. Because there is evidence of a destabilization of the vago-vagal feedback loop in bulimics (Faris, 2006, 2009), relapse is common and beyond the locus of control of the sufferer once the binge-purge cycle becomes ‘hard-wired’. This requires a titration of the nutritional reeducation phase within the client’s window of tolerance to try feared foods and tolerate fullness. In my experience, my bulimic patients have the highest states of hyper-arousal and require significant assistance to develop somatic grounding, orienting, and settling skills before they can be helped to discharge the activation they experience, which is usually expelled through excessive exercise, vomiting or laxatives until other skills are developed. A 22-year-old was continuing to have intense urges to purge and selfharm through cutting after almost one year in residential treatment and was afraid to leave treatment. She was frightened to address the childhood sexual abuse trauma that led to her symptoms. Learning that she could process her trauma response somatically, without verbally having to tell the story, increased her willingness to see me. I asked her to “walk-and-talk” outdoors in order to increase orientation to safety in the here-and-now and movement to decrease the sense of immobilization by fear. While walking, I asked her whether the trauma memories consisted of thoughts, sensations, or images. She replied images, stating that one predominant image caused her the highest distress. She was instructed to “freeze” the image and place it at a distance of her choice, granting her the power that she lacked during the initial event. This allowed her to begin to tap into the body sensations associated with the experience and safely discharge them, while also helping her differentiate (or uncouple) the stress of lifethreatening fear from the stress of a final exam; this allowed her to tolerate returning to school. Next, we addressed the impulses to self-injure, which she described as serving a function to orient to the source of the threat (“at least I know where the pain is”), as well as to provide numbing, which she described as “floating in a pool of warm water.” She was “prescribed” to float in her pool daily with mindfulness to experience the soothing effects. Finally, she was asked to use expressive art to “yell” the “NO!” she was unable to voice. Together, these and other sensorimotor interventions allowed her to quickly feel that she could ‘move on’, discharge from treatment, and return to college. Case Study: Binge Eating Disorder Overweight/obese compulsive overeaters and binge eaters, on the other hand, display similar shutdown or disconnection from internal states as anorexics. Anorexics become significantly aroused by the feeling of food in the stomach, while overeaters are triggered by the sense of emptiness and hunger – even if at a more subconscious or autonomic body level. These groups require help in increasing awareness of arousal states through skills in tracking bodily sensations mindfully so these arousal states can be safely discharged and not induce either starving/dieting or overeating behaviors. A 56-year-old widowed woman with a long history of binge eating and struggles with weight management described her experience as one of core emptiness and desperate loneliness. Her longing for connection and to “fill the void” led her to nightly binges that filled her up physically (which she recognized only when extremely full) but not emotionally. Every episode increased her despair. Additionally, she described feeling invisible to the world around her when she was growing up and needing to generate greater body mass and “take up a bigger space” in order to “be seen.” Sadly, because of social discomfort with largeness, she had become a target of bullying to those who would shame her for her size and of greater invisibility to those who would just look away to avoid their discomfort. Gradually, through mindfulness training to increase interoception, and body movements to engage a sense of core strength and embodiment, she began to notice and become aware of the fact that “the emptiness is not so empty.” Her ‘authentic self’ began to fill her, and she felt less need to binge and greater satiety when eating foods that pleased her. Summary The use of mindfulness and somatic practices that increase body awareness, assist in the regulation of autonomic hyper-arousal or hypoarousal, and discharge the ‘undigested’ survival energies of trauma, is quickly gaining relevance in the treatment of eating disorders. Yoga, the expressive arts and psychodrama, movement and dance therapies, and integrative mind-body psychotherapies such as Somatic Experiencing® (Levine, 1997, 2010) are increasingly available at treatment centers. These approaches increase interoceptive and proprioceptive awareness through the use of sensorymotor tracking skills that strengthen the insula, the anterior cingulate gyrus, and the connections between Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 62
and cortical areas (Holzel et al., 2010). Regardless of the eating disorder presentation, somatic awareness to deepen therapeutic interactions, provide access to disconnected emotions and sensations, and nurture a sense of ‘safe’ embodiment becomes crucial to healing. Overcoupled and undercoupled aspects of the person’s experience (affects, sensations, images, behaviors, and meanings) can be gradually integrated to restore a person’s sense of wellbeing and resilience. This includes the internal hunger, fullness, and satiety cues necessary to establish long-term recovery and end the dieting, starvation, binge eating, and purging cycles. To summarize, because eating behaviors have been equated with stress at a sub-cortical, midbrain level, it makes sense to incorporate practices that take patients ‘beyond talk’, especially when the reasoning, cortical brain is off-line due to starvation or malnutrition. Since the body is the battleground of the emotions, therapists and their clients might benefit from understanding the language the body is speaking. Inge Sengelmann LCSW, SEP is a licensed clinical social worker, Somatic Experiencing® Practitioner (SEP), and yoga teacher focusing her practice on the treatment of eating disorders and trauma. At The Counseling Group in Miami, she is a founding member of an intensively-trained Dialectical Behavior Therapy (DBT) consultation team and the DBT outpatient treatment program for eating disorders. Inge is in the process of completing the ParaYoga Master Training curriculum with her teacher, Yogarupa Rod Stryker, and has been initiated into the Himalayan Tantric lineage of Sri Vidya. Tranta’s main focus is accelerating transformation using ancient wisdom practices tailored to each person’s specific needs. Weaving ancient and modern wisdom, Inge integrates the latest developments in the field of affective neuroscience with mindfulness and yoga practices to inform her work with clients. She has been active in the Miami Chapter of iaedp (International Association of Eating Disorder Professionals) and teaches workshops for practitioners as well as clients. She has presented locally, nationally and internationally on the topic of eating disorders, somatic psychotherapy, and integrative mind-body-spirit healing. For more information about Inge visit www.IngeSengelmann.com Eating Disorders is contemporary and wide ranging and takes a fundamentally practical, humanistic, compassionate view of clients and their presenting problems. You’ll find a multidisciplinary perspective that considers the essential cultural, social, familial, and personal elements that not only foster eating-related problems but also furnish clues that facilitate the most effective possible therapies and treatment approaches. A distinguished international editorial board ensures that Eating Disorders will continuously reflect the variety of current theories and treatment approaches in the eating disorders arena. From anorexia nervosa to bingeing to yoyo dieting, editors and contributors explore eating disorders from a number of exciting, sometimes unexpected, and always thought-provoking angles. References on page 109 Somatic Psychotherapy Today | Fall 2014 | Volume 4 Number 2 | page 63
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