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Friday, August 17, 2012

“Do or Do Not. There Is No Try.” Think Again, Yoda.



I support mindfully eating these "black and whites" but not the
thinking by the same name.
She comforts with food, rewards herself with food, punishes herself with food. She eats what's served to her by her spouse—even when it's too much and she feels uncomfortably full. Nightly ice cream and dessert are the norm—on the couch, distractedly, while watching TV, simply to numb, barely tasted, never enjoyed. She's a self-described emotional overeater, also treated for depression. And she reports gaining over 20 pounds the past few months.
And then the work began.

Sharon is a 45 year old who first came to see me at the end of May, for weight and blood pressure management. She's had a range of medical issues including cancer, but her greatest distress was her weight and unhealthy eating habits. Her main goal was to lose weight from her high BMI, and to learn to eat healthier. She also suffered from diarrhea, the consequence of a medical procedure, making it more challenging to head outdoors to exercise; or, to even want to exercise at all, for that matter. 


Be positive. Really?

Do you emphasize the half or the full?

One of the recent goals we've been working on has been to identify some positive changes she has experienced between our visits. I must admit—this is where she really fails! Getting Sharon to credit herself for anything positive is like pulling teeth. 

She keeps my expectations low—she prepares me to expect little from her, with her self-deprecating words. And with her persistent focus on what's not in place, I’m forced to reality check and remind myself just how well she is progressing. Here’s a window into our session:

I praise her for beginning the process of contemplating exercise, by exploring the on demand cable exercise programs—first, just watching them, then moving to participate for the half hour session. But she replies, “yes, but I only did it once.”

I acknowledge that she got back to the gym after a long hiatus, and what does she respond? "I got there only three times”. “That’s three times more than last week!” I add. She rebuts "but I only did the bike", as if the 45 minutes on this piece of equipment didn’t even count, because, as she stated, "I planned to go more and I didn't". 

I remind her how she has been diligently recording her food, identifying her hunger and her eating triggers. But she replies “but I didn’t get to record for a couple of days”.

I noted how impressively she followed through with bringing lunches from home, but she admitted that she didn’t eat them every day—because it wasn’t always what she felt like eating.
“Wow, you’re paying attention to how things taste, to what you feel like eating—that is progress!” And she admitted defeat. She was being too hard on herself; it’s something she’s long struggled with. She began to describe how thirty plus years ago, when she was only a teen, she heard something she has never let go of. It was this: 





“Do or Do Not. There Is No Try.” The perfect philosophy


Precontemplation: Not even ready to consider thinking about
going for a walk.
—for a black and white thinker, that is. On or off, good or bad, dieting, or binging—hardly an approach I can endorse. Instead, I educated her about Prochaska’s Stages of Change Model, a theory about the process of changing behavior, which is much more nuanced than that of Yoda. This model acknowledges that behavior change is an ongoing process, and that there needs to be appropriate pairing of recommendations to one’s readiness to shift where they are at. So for Sharon, a non exerciser, her move to find an exercise program on TV, and then to choose to watch it to get more comfortable with the idea, was an absolutely appropriate shift—much more so than if I had instructed her to go from zero to 60 minutes per day of running several times per week. That would have set her up for absolute failure. Or if I had suggested she had to prepare a lunch from home every day—and eat it—when she hadn’t even made shopping a priority.

Prochaska’s Stages of Change model describes 6 stages that individuals go through—not necessarily in a straight line or in one direction. They may even hover in one stage for a while—until they are ready to move on. The stages include pre-contemplation, contemplation, preparation, action, maintenance, and relapse. Yes, there’s even a relapse. This guy knew what he was doing, didn’t he? He spent a great deal of time studying smokers and drinkers and others as they tried to shift toward healthier behaviors. And the resulting model has informed us about what works for clients dealing with changing their eating and activity—as well as their expectations for change.


See where this is going?


Contemplation stage: "I'm thinking about getting up
to eat my dinner, but I'm just not ready yet."
If Sharon keeps expecting to change by leaps and bounds when she is just contemplating action, she will continue to be disappointed. And if she thinks that slips don’t happen—that relapse has no place—then she is equally wrong. But if she can more compassionately acknowledge that there is a process going on and that action is only one visible step in that process—then she will have success. Setting unrealistic goals is a self-fulfilling prophecy. Yes, you will be a failure if you set yourself up for failure.


Back to Yoda.


I’ll admit it—I’ve never been a Star Wars fan. And this quote Sharon shared does nothing to endear me to Yoda. But then I watched this other movie clip that went beyond that short, all-or-nothing statement. 

Forget what you learned.

Yes, with all the misinformation and craziness out there, this one I can endorse! It’s funny that it’s stated in the same frame as the more well-known quote above. And, I suspect, it simply gets missed.

Yes, Sharon, it’s time to forget the diet rules and the self-destructive thinking. It’s time to forget the failures you’ve come to expect and to hold on to the hope.

And I do expect to see a list of positives from you—at least when you are ready to accept that you are truly doing well.




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