Stress and Emotional Eating: Using Cognitive Behavior Therapy to Break the Habit

Most of the dieters whom I treat overeat when they’re feeling stressed or experiencing a negative emotion such as anxiety, sadness, anger, shame, and so on. They often have one or both of the following unhelpful ideas:

 “There’s nothing I can do to calm down when I’m upset.”

“I deserve to eat when I’m upset.”

As long as they hold beliefs like these, they will remain vulnerable to regaining the weight they have lost. They need to change their thinking. They need to learn how to accept and tolerate negative feelings and how to cope with stress in more healthy ways.

Katie, a dieter whom I saw last year, had been doing so well initially. Early on, she was highly motivated and was able to stay on track even when she was upset. When she became upset, she would tell herself, “NO CHOICE. It’s not time to eat. I CAN’T eat now.” She would turn her attention to something else, her negative feelings would slowly subside, and she’d feel proud that she had stuck to her plan.

But then Katie went through a particularly stressful period. Her father was hospitalized. Her youngest child started having problems in school. She got a new supervisor at work who was making unreasonable demands on her. Katie continued to follow her eating plan throughout each day. But come 9 pm, when her children were in bed, the permission granting beliefs above led to Katie’s consuming “all the carbs I can get my hands on,” until she went to sleep. She quickly started regaining the 22 pounds she had lost. She was frustrated and angry at herself but couldn’t seem to stop.

First Katie and I did some problem-solving. As soon as she got her kids in bed, she would decompress by doing deep breathing and then she’d have a cup of herbal tea. Next we did some cognitive work. Following our discussion, Katie composed messages on index cards which she was to read each day after work, just before she walked in the house. She was to read them again as she was sipping her tea. This is what Katie’s cards said:

“If I want to lose weight permanently, I have to stop eating when I’m upset—every time. People without weight problems don’t eat when they’re upset. They either tolerate their negative emotions or try to solve the problem or call a friend or take a walk or go online or read a magazine or watch television. But they don’t eat.”

“Negative emotions are uncomfortable but not dangerous. I don’t have to “fix” them. I’ve had lots of times when I’ve felt very upset but I haven’t eaten. I’ve never exploded or lost control. The worst thing that will happen if I don’t eat is that my distress will peak and then the intensity of my emotions will go down. “

“If I eat, I’ll be temporarily distracted from my distress but whatever problem led to my distress in the first place will still be there and then I’ll also have the problem of feeling badly that I ate and I’ll really feel badly when I see that the scale has gone up.”

Katie also started back on Day 1 of the cognitive behavioral program for weight loss and maintenance so she could sharpen her skills of re-motivating herself, gaining confidence by giving herself credit, tolerating cravings, and getting back on track immediately when she made a mistake. The incidence of her eating for emotional reasons declined sharply. She slipped a few times but the challenge became easier and easier as time went on. The chance that Katie will be able to maintain her weight loss into the future has increased exponentially.

Making Friends With Food– An article in SHAPE Magazine

In the October 2009 issue of SHAPE magazine (see p. 70), a dieter tells readers how Dr. Judith Beck (and The Beck Diet Solution) is helping her develop strategies to target her emotional eating, boost her confidence, resist unhealthy temptations, and continue to lose weight.

In the article, the dieter mentions a favorite strategy that’s been helpful to her and which Dr. Beck emphasizes with all dieters:

Identifying and reminding oneself of the advantages of losing weight

She explains that when she becomes tempted by a bag of chips, she runs downs her list of why that bag of chips is NOT worth it. She also talks about how Dr. Beck has taught her the importance of giving herself credit—and that she deserves credit EVERY time she proves strong enough to resist and stick to her plan.

The Other Side of Emotional Eating

Over the weekend our dieter, Kathleen, received some very good news: her son announced his engagement to his long-time girlfriend.  Kathleen was overjoyed at the news and after their conversation, she felt keyed up.  Although the emotions she was experiencing were joyous, the sensation of experiencing even a strong positive emotion was vaguely uncomfortable – and wouldn’t have been much different than if she was actually experiencing negative emotion. 

Kathleen’s old habits kicked back in to deal with this feeling of emotional arousal. Soon she gave into sabotaging thoughts and “found” herself standing at her kitchen counter, eating a peanut butter sandwich.  As soon as she finished the sandwich, Kathleen realized that she had barely tasted it and was upset that she went off her plan.  The problem with Kathleen’s situation was that she was caught off guard.  Kathleen had often practiced feeling negative emotions and not turning to food, but she hadn’t even thought that positive emotions might lead to the same outcome.

We discussed the situation with Kathleen in the same way we discuss any incident of emotional eating.  Looking back at the situation, Kathleen realized that she should have dealt with her emotional arousal in the same way she always does – by distracting herself with activities, such as walking her dog, taking a hot bath, or polishing her nails.  Kathleen now feels confident that she can deal with any strong emotion without turning to food.

Rules for Traveling

When traveling and staying in a hotel, dieters may be tempted by the treats in their hotel rooms. Hotels are smart – they often leave a basket of snacks in full view so they can tempt people to spend money (Day 32 of The Beck Diet Solution). But dieters can take the basket and put it in a closet or cover it with a towel and develop a rule to always carry their own treats with them instead of eating anything from a minibar, basket, or snack machine. If they’re hungry, it’s important for dieters to remember that they’ll have their next planned meal/snack within a few hours or have breakfast the next morning (Day 16 of The Beck Diet Solution).  We ask dieters to imagine if this were thirty years ago when there was no food in hotel rooms.  What would they have done then? 

Our dieter, Jason, had to apply this rule in a different way.  He travels for business once or twice a month and there is always an abundance of snack food at the back of the meeting room. He often feels either bored or somewhat stressed during meetings and it is particularly difficult for him to resist the high fat, high sugar foods. Jasonknows that eating these snacks is contrary to his plan, that he will soon feel weak and guilty, and that he could gain weight, he still has a hard time resisting in the moment.  Jason needs to read the advantages of losing weight just before each meeting. He’s also decided to make a rule for himself that he will not eat any snack food provided at meetings. It’s helpful for him to realize that he’s not alone—not everyone at the meeting eats these snacks between meals. Just like the minibar, he can’t give himself a choice about this or he will struggle every single time.  As soon as Jason makes this rule and practices following it ten times in a row, it will become so much easier for him to resist and stick to his plan.

Emotional Eating

Our dieter Rose has a very stressful situation coming up this week and so we spent a lot of today discussing emotional eating and strategies for not falling prey to it. Lots of dieters are like Rose. They feel entitled to eat when they’re distressed. “If I’m upset, I should be able to eat.” Often, they feel as if they don’t have a choice. “If I’m upset, I have to eat.” It’s important for them to recognize that people without a weight problem usually do not turn to food when they’re upset. They try to solve the problem, turn to others for support, distract themselves, or simply tolerate the feeling.

These are the strategies that Rose needs to learn. But first, she needs to label her experience. “I’m not hungry. I just want to eat because I’m upset. But if I eat, it will only be a temporary ‘fix.’ I’ll feel so much worse afterwards.”

Ultimately, we want Rose to learn that she doesn’t have to do anything when she’s upset. Negative emotions won’t harm her and they’ll subside even if she does nothing. But as an intermediate step, we advised Rose to make a long list of things she can do to comfort or distract herself, such as taking a walk, checking her email, calling her best friend, writing in a journal, listening to a relaxation tape, and taking a hot bath.  We asked Rose to try at least five things every time she feels upset. We told her she needed to have about 20 experiences in a row of not eating for emotional reasons in order to really feel confident that she has broken the habit of turning to food for comfort. 

What are some of the things you do, other than eating, when you’re upset and have an uncomfortable urge to eat?

Emotional Eating: Diana

Some of our dieters have been recently dealing with the issue of emotional eating.  Diana in particular has noticed this because she’s coming up to the anniversary of a loved one’s death.  What’s interesting about Diana’s situation is that originally she wasn’t even fully aware that the anniversary was looming; instead she just noticed feeling more emotional and having an intensifying desire to eat to comfort or distract herself. 

During the group today we discussed that dieters need to remind themselves that eating will only serve as a temporary distraction; it won’t solve the problem.  And actually, unplanned eating will only cause dieters to have two problems – the original problem, and now the additional problem of going off plan, feeling weak and out of control, and potentially gaining weight.  Dieters need to squarely ask themselves, “Do I want to have one problem or two?”

It’s also helpful for dieters to remember that there is no direct link between feeling bad and eating.  Naturally thin people, and people who have lost weight and maintained their weight loss, don’t turn to food for comfort. The former often don’t because it doesn’t even occur to them, and maintainers don’t because they know that they simply can’t emotionally eat if they want to keep the weight off; they know that they have to find other ways to find comfort.

We also discussed the notion that negative emotions are a part of life, and that it’s okay to feel badly sometimes.  We live in a feel-good society where many people think that experiencing negative emotions is somehow bad or wrong.   It’s important for dieters to learn that they can tolerate feeling bad and that it’s perfectly normal.

 To deal with this difficult time, Diana is going to try praying more often and drinking soothing hot tea.  She’s going to remind herself that negative emotions are a part of life, and that at the end of the day she’d rather only feel bad about one thing and not two.  As she succinctly put it, “Time does heal you.  Food does not.”