Mindfulness in eating disorders: Interview with Carmen Bayón

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Carmen Bayón Pérez is a psychiatrist and currently works at the University Hospital La Paz in Madrid, attending interdepartmental and bringing the program link with HIV infection and multiple sclerosis. She is also responsible for Personality Disorders Program Area 5 and works as a supervisor and teacher at the Psychotherapy Unit of the same hospital. For many years she was responsible for the program of eating disorders in a CSM. She was formed in the area of Personality Disorders at Washington University in St. Louis with Professor Cloninger CR, focusing its expansion of knowledge with the psychobiological model of Cloninger. As tutor of residents and students actively involved in shaping them. She is associate professor of psychiatry at the Autonomous University of Madrid, and is integrated as a professor in the Master of psychotherapy integration where Dr. Rodriguez Vega and Dr. Fernández Liria are directors, participating with this doctor in investigating psychotherapy the field of oncology. His work on eating disorders has focused primarily on clinical cases with comorbid personality disorders. He has conducted research on obesity participating in the design of a study in which a branch Mindfulness-based intervention was used. His experience is therefore both clinically as teaching and research.
The course on “Mindfulness and Eating Disorders” integrated into the advanced training course for therapists, organized AMyS, he has been taught by this professor and psychiatrist who has very kindly agreed to answer our questions.

AMyS.- Thank you for this interview.The first question that I think is typical question is about what took therapists in general and specifically to you, to consider applying the practice of mindfulness to these disorders. why mindfulness to treat eating disorders?

C.B.- The idea to start applying techniques of mindfulness in eating disorders was based on clinical experience I had with certain groups of patients.In some cases prevailed a state of severe malnutrition by dietary restriction which was associated with cognitive restriction, this made them forget what had been discussed during the session and failed to focus during the session, so I realized that “speak” not going to help these patients. In other cases, patients had an emotional overflow which made could not think clearly, and therefore could not express clearly what was happening. I realized that the way of working in which predominated speak not served in these cases or times and had to get overcome this obstacle and approached techniques for working from the body, from the bottom up, the whole process sensory and processing of emotions and one of the tools to work on interventions from the bottom up, is Mindfulness or Mindfulness techniques ..It was then, and this makes 8 to 10 years, you get into exploring different techniques, different therapies, and Mindfulness hooked me, not only on the issue of patients but for myself.It is something that has helped me personally, and right now, I use it with most patients regardless of diagnosis. Mindfulness is useful and beneficial as a tool in a psychotherapeutic process.

AMyS.-As said before, Mindfulness facilitates learning in general.
C.B.-Right, why it has no place for any pathology.

AMyS.– As distortion of body image with these patients how work?What place does the practice of body-scan, yoga?

C.B.- Well, for distortion of body image body-scan, that is, the observation of the body, is essential.Teach them to feel full all parties and become aware of each consciousness. There is an alteration in the body schema, where some body areas are printed on the crust with more force and other areas are completely blurred. Through the body-scan, body review, Mindfulness movement with gentle yoga exercises, you can increase the interoceptive awareness.

AMyS.- Are there scientific studies that support this type of therapeutic interventions demonstrating its effectiveness compared to other treatments?

C.B.- Yes. There are scientific studies, especially binge eating disorder and bulimia nervosa.The mindfulness – based cognitive therapy, dialectical behavior therapy adapted for binge eating disorder and bulimia, and mindful eating training designed by Kristeller are some guidelines that are working on population eating behavior disorder. Most of the studies are not clinical trials do not compare to other therapy, and therefore design more methodologically rigorous studies are missing, but progress is being made in this area. I remember the existence of a study comparing the effectiveness of training in mindful eating (MB-EAT) with a psychoeducational group intervention based on cognitive therapy and a waiting list control group.It was shown that in both groups had decreased depressive symptomatology and reduced bingeing. However, only in the group assigned to MB-EAT greater internalization of change by showing changes in the locus of control about food was obtained. We need to track these patients, but we could assume that there is a persistent improvement. What has been demonstrated in this group of disorders is that cognitive therapy is effective, but there are a large number of relapses in the follow-up. Mindfulness-based interventions may help stabilize the improvement over time.
Also, when using Mindfulness working with thoughts, emotions with bodily sensations, you work with the identity of persons.

AMyS.- Can be preventing the practice of Mindfulness submitted prior to the disorder as such?How can you escape the current flows prototype model, diets, beauty canon, advertising campaigns…?

C.B.-CB It would be talked more about prevention in the social context. That is fundamental. We must change the messages that are being sent through society. I teach eat consciously and that has to do with education, eating without television, eat slowly, without a computer, eating talking.Teaching parents to teach their children to eat consciously, enjoying every taste, every smell, color and thanking each having food on your plate before you.

AMyS.– How to get to practice mindfulness, when the patient is at a time of crisis, or high severity of their disorder? It can be applied in such cases?

C.B.- No, no. when there is an emotional behavioral escalation and therefore, it is very difficult at that time to perform Mindfulness, unless they have had prior training and are using it in their daily lives.It should be distinguished. If it is a serious disorder, which take a long time, or have very disruptive behaviors like that is continually throwing up, if gravity is that, yes you can work with Mindfulness.If it is a given patient is at a moment of crisis, with great emotional, continued to overflow, and is in vital risk, I think you need to do containment and maybe even hospital. There are very serious patients, who at one point are very dysregulated. No can we believe that we are gods or that this is magic… no, no.

AMyS.– During treatment distinct phases occur, and suppose that the techniques applied will not be the same in all of them what would those used at each stage?

C.B.- It is one of the things that I have clear and that would be one thing to investigate.When, or what kind of meditation practice used at all times? If you work individually with a patient, effectively what you do is make a psychotherapy for the patient. Then you will use Mindfulness, you will use elements of cognitive therapy, narrative therapy, talking, … ..any tool and Mindfulness practices are going to introduce that as long as you see it is the right time And if we work in a group, what kind of patients incorporate the group? in that moment? What is being done now is start groups and include patients with the clear objective of working with binge eating. For example Dialectical Behavioral Therapy work with binge eating or vomiting, with problem behavior and perhaps not you get both who I am, I do in this life, in interpersonal relationships, leave it for later.

It is not so much the time of disease but which behaviors are more apparent at that time…

AMyS.- How interventions are developed, are the group sessions, individual, combined?

C.B. It depends on the therapy.In the dialectical Behavioral Therapy is a working group with no individual interventions. They do group therapy 20 sessions. The acceptance and commitment therapy, there is no study, but may be valid, the used individually above all, very directed to moment that the patient is. Therapy “mindful eating” only makes group intervention. The studies that have been done have been with group interventions, but you can make individual interventions, because this makes sense,

 AMyS: Is it not necessary then group work?

C.B.– No. The group is giving the possibility to have different experiences, is not only mine, it’s the other also.This topic helps a lot and we can not lose sight. Perhaps group techniques to do at first, pass individual, group … then again. We are talking about serious and chronic disorders often, if not the catch from the beginning, which have for many years …. and bulimia usually take years, because hidden behaviors do not appear before the treatment. Probably what we need are long-term therapy, where you can work this out, then stop, back with individual therapy, group work now at the interpersonal level, etc.

 AMyS.- What I gather is that it is rich in all yet not so much with a basic, single model but a continuous flexibility.

  C.B.- Yes, that’s my usual way of working.

AMyS.- Working with eating habits and promoting self-care?

C.B.  There is a book Thich Nhat Hanh, Savouring, eat conscious, conscious life focused on this, working with eating habits and encourage self – care, not only through the style of eating but also through food. It teaches us to eat consciously, to abandon feelings of guilt and shame that come from ruminating about what we have eaten and not eaten on the exercise we did or did not do, teach us to focus and live in the present, the moment when we have the power to make changes in our lives.By eating consciously, with full attention, listen to the signals of hunger and satiety, we distinguish these more physiological signals with signals that have to do with emotions, and therefore we simply eat to silence the negative emotions. The exercise consciously is much more rewarding, be aware of the change that occurs in our body after exercise, new sensations appearing, enjoy the fullness.

AMyS.- What about impulsiveness, self – destructive patterns, how we work with Mindfulness?

C.B.- First, Mindfulness is to be with the desire or emotion that leads to impulsive behavior, then Mindfulness is to observe and describe what is happening even before such behavior appears, either addiction, whether smoking, binge eating …. being with emotions, to feel them , tolerate them , experiencing that are able to not answer automatically, what we call react.From there, you can choose the wise mind, choose freely, I am responsible for the conduct, I am not controlled by impulses.

AMyS.- What intervention is performed when there is an associated pathology, it intervenes differently than when presented only eating disorder?

C.B. Not really. Mindfulness techniques include a treatment protocol is good and always effective. Mindfulness is something that helps in personal growth and development to achieve a welfare state.

AMyS.- Since when this type of intervention is applied with such disorders in Spain?Are you extended your practice?

C.B.- I could not tell exactly.What I know is that more and more professionals interested in Mindfulness, more and more people who are doing training in Mindfulness … there., But then to it being applied in their consultations… I don’t know. My impression may be wrong is that we are at the beginning in Spain, what they are doing is professional approach it.

AMyS.– What it is the characteristics affected that are working more and more may be subject to intervention?¿Impulsiveness, obsessive thinking, self-esteem, etc?

C.B.– I emphasize that we work with Mindfulness is awareness, making somatic awareness, interoceptive awareness, that part which is fundamental to then continue by telling it you who you are.It works with emotions, helps to tolerate and regulate emotional experience and work with thoughts to observe, without judging, without getting hooked to content, watch as mental events that come and go and do not have the power to define who you are. Thoughts are sometimes harmful, deceive us with Mindfulness learn to listen to the body, which tells the truth, you can not fool the body, if we deceive ourselves with the mental contents, they are often distorted by the past. So I would say you work especially Interoceptive increasing awareness and promoting integration work especially. If you want to go to… symptoms it is the same.What you work is the basics of who you are, it is the self, now there is talk about Not Self, but , you work with at least know who I am at this moment, here and now.

AMyS: We will not end the interview without thanking their collaboration, especially thanking him for his words, for sharing his knowledge with us and especially for the serenity and the knowledge it conveys.Thank you very much for that.

We want from these lines show our appreciation to Maria Eugenia Moreno García, psychologist , therapist and clinic director of CTA eating disorders, in Valencia, for their kindness and advice in the preparation of this interview, instructing about these disorders and patients.

By: Vicenta Navarro Orriach