Feb 23, 2015
Marion MacDonald

TRE (Tension + Trauma Releasing Exercises)

By Tara Shultis, MA, LMT, TRE Practitioner

TRE® is an innovative series of exercises that assists the body in releasing deep muscular patterns of stress, tension, and trauma. The exercises are simple, easy to learn and safely elicit a natural reflex mechanism of shaking and/or vibrating that calms the nervous system. TRE was developed over 20 years ago from Dr. David Bercelli’s work with large traumatized communities in the Middle East and Africa. His observations led him to understand that this shaking or vibrating is the body’s built-in healing mechanism to quiet the mind and release chronic tension.

We learn through social cues to turn off this natural shaking mechanism, but in extreme cases i’ts nearly impossible (for good reasons) to control the body’s natural response to trauma or stress. Perhaps you’ve experienced the aftershock from a car accident so intensely that you “shook like a leaf”. Or, after your body rushed to escape danger, you quivered with fear. This shaking mechanism is wired into our nervous systems to release what is no longer necessary once the body is out of harm’s way. We refer to TRE as a self-healing technique because we induce the therapeutic tremor in a safe environment on our own schedule. Once we learn how to safely and effectively elicit the therapeutic tremor on a regular basis, we are more accepting of our body’s natural response to stress.

Whether someone has experienced a traumatic life event or accumulated stress over the course of a lifetime, releasing unnecessary tension helps the body and mind return to a more calm and peaceful state. Since its development, TRE has helped thousands of people worldwide in more than 35 countries reduce the effects of stress, tension and trauma. The reported benefits of a regular TRE practice include, but are not limited to:

  • less worry and anxiety
  • better sleep
  • fewer PTSD symptoms
  • reduced muscle + back pain
  • more energy and endurance

Most relaxation techniques rely on conscious control. TRE relies on unconscious control, allowing an individual to listen to music or watch TV while the involuntary muscular shaking process does all the work. As part of Mirasol’s integrative approach to eating disorder treatment, TRE expands the client’s ability to control emotions, sensations, thoughts, and feelings independently of external supervision or regulation. Once learned, TRE is a self-healing technique and prevents the accumulation of chronic stress, tension and trauma.

During a typical TRE session, whether it’s an individual or group session, each client is guided through the series of seven exercises by one of our certified practitioners to safely and effectively elicit the therapeutic tremor. Clients receive individual support to help regulate and modulate the tremor to their levels of comfort and resilience. Clients are asked to rate their emotional and physical well-being before and after each session to determine the overall effectiveness of TRE.

For more information about TRE please visit www.traumaprevention.com

Feb 16, 2015
DrDawn

Six Times a Day?

By Dr. Dawn Bantel, Staff Physician

Yes, we eat six times each day.  This is one of the very first conversations that I have with a new client when she enters treatment.  This concept is so difficult for someone with an eating disorder.  In fact, it’s pretty mind-blowing for her.  She always thinks that there has to be some control or compensation involved to maintain a healthy body weight.  This is generally true for all the eating disorders.

Our dieticians create a meal plan that is composed of three meals and three snacks per day.  It is adjusted for the calories needed for weight gain, weight loss or weight maintenance depending on what the client needs.  If one is on a weight loss meal plan it is possible to loose weight by eating six times per day! The client never believes this until it actually happens.  She doesn’t have to restrict/purge/exercise to loose weight and she doesn’t get hungry.

Hunger and low blood sugar can contribute to a binge.  If a client is satiated from eating just a few hours before, she may make better choices.  Also, low blood sugar will create a strong desire to acquire a quick fuel source such as ice cream, energy drinks, candy, etc.  People with eating disorders are usually stuck in a cycle that they are unable to interrupt.

For the client that has a history of restriction it is easier to eat the required number of calories in six portions through out the day.  Usually, she will experience improved mood and improved cognition with regular eating.  In fact, the majority of clients will admit to how impaired they were before eating regularly.

Most staff will become accustomed to eating six times per day.  We pull out our snacks right on schedule as our appetites are used to eating this way.  It helps to maintain our energy too.

Feb 11, 2015

Turning Points

Many clients feel overwhelmed during their first few weeks at home after eating disorder treatment.  I’m thinking of a particular client — I’ll call her Suzi.  While in treatment for bulimia, she tried hard to work on the issues that were at the heart of her eating disorder.  She participated in ALL of the physical activities — the gym, yoga, hiking.  She told her therapist everything she felt safe telling her about her life. She she tell her about all her fears?  Maybe not …

In her first week at home, Suzi was overwhelmed by fear even after seeing her therapist.  She tried to remember what she did before treatment when she had such strong feelings.  Ah, of course!  Purging  took away the fear and numbed her so she wouldn’t feel anything.

Two weeks out of treatment, Suzi was at a turning point. Would she decide to use the tools she learned in treatment or would she continue secretly binging and purging? 

In most treatment programs, staff is judicious in teaching the client exactly what to do every day after she leaves treatment.  She can be in touch on a daily basis with her aftercare counselor.  She can begin the day with an inspirational reading and a few moments of deep breathing.  She can plan what she’s going to eat for the day.  She can plan exactly what part of her day might produce anxiety or fear and what she’ll do if that happens or even who she’ll call.  These are merely a few examples of what might work for Suzi.  Hopefully she has a structured plan she made while in treatment.  The plan is something that she can immediately fall back on when and if she begins to struggle.

The road to recovery is long and hard. No one travels it perfectly.  There are many slips, trips, and lapses. Those who eventually do recover learn to pick themselves up, shake it off and keep on going. By doing so, they keep small slips from turning into full-blown relapses.

Suzi has a choice — which will it be?

Jan 15, 2015
Heather Purdin

RESHARE: Insurance Companies Coming Up Short

RESHARE: We fully credit this article to PRWeb.

Eating Disorder Treatment Rarely Fully Covered by Insurance Companies, Lisa S. Kantor of Kantor & Kantor, Offers Helpful Information for Families and Loved Ones

Insurance denials can be life-threatening and now, insurance companies are starting to feel the pressure to recognize eating disorders as a serious mental health issue, says Kantor.

Northridge, CA (PRWEB) January 13, 2015

Dealing with an eating disorder is extremely challenging and being denied insurance coverage makes these times more stressful than they should be. Looking to the insurance provider to fully cover treatment is often a mistake since it will leave patients and their families caught off-guard. Insurance companies are feeling a huge amount of pressure to see eating disorders as a serious mental health issue.

According to the New York Times, an estimated 11 million Americans, mostly young women, suffer from eating disorders, the most serious being anorexia nervosa, in which people starve themselves, and bulimia nervosa, in which they engage in binge eating followed by purging. These disorders, particularly anorexia, have the highest fatality rate of any psychiatric disorder,” (Eating Disorders a New Front in Insurance Fight: New York Times, October 13, 2011).

The Employee Retirement Income Security Act (ERISA) governs if the patient has insurance through their employer. Policyholders need to pay attention to authorization of a treatment, payment time, and where they can get the treatment they need.ERISA is tricky and often interpreted to the benefit of the insurance company. The court will often consider only documents which are part of the insurance company’s file so make sure copies of all documents are sent to the insurance company. Additionally, policyholders should read their policy thoroughly so they know what is covered and their rights under ERISA.

Patients have a choice of staying in-network or choosing a doctor or facility out-of-network. Challenges include covering out of pocket costs, authorization by the insurance company, being allowed enough time to stay in treatment to get well. A key factor is educating facility administrators on how to deal with insurance companies so everyone gets better outcomes. The best way to approach eating disorders is to treat to the outcome, not be limited by insurance. There is a lot of hope for recovery and it is important that insurance denials do not get in the way of helping those with eating disorders.

Families of those suffering from eating disorders are strongly urged to look at what resources they have before deciding the course of treatment.  An insurance company may not see certain treatments the whole way through although many residential facilities succeed in helping patients no matter what. (How to Fight for Coverage of Eating Disorder Treatment, Nasdaq.com, January 07, 2013)

Insurance denials can be life threatening.  Knowing the reason behind an initial denial is the first step towards appealing the decision. The insurance company may not see the eating disorder treatment as medically necessary but lawyers can help with the appeal process or file a lawsuit against the insurance company. Always talk with a doctor about what treatment is needed since the insurance company will almost always make business-based decisions.

Watch Video

“Everything must be in writing,” states Lisa S. Kantor, founding partner of Kantor & Kantor, LLP. “These can include letters of support from doctors, dieticians, family members, and even home videos. Make copies of any documents you have and submit them to your insurance company. The more you can document the better your chances are for a successful claim. I recommend taking notes when talking with the insurance company and confirming the conversation in writing.  Just remember, it didn’t happen unless you write it down and mail it to your insurance company.”

When the insurance company is making a business decision about coverage, it is necessary to fight with them to get the needed medical coverage time in treatment. . The fight is ongoing against insurance companies to cover treatment for eating disorders so don’t give up because one day the struggle should end and loved ones will get the coverage they need.

For resources and more information, visit our website or call 888-569-6013. Lisa Kantor is available for interviews, call Phoebe Nolan or contact Lisa on Twitter @lisaskantor.

 

Jan 9, 2015
Heather Purdin

Digestive Disorders Masked by Eating Disorders?

From Mirasol ED Recovery Guest Blogwriter ~ Faith

As with any mental health diagnosis, eating disorders come with many stereotypes. Most often, eating disorders tend to be oversimplified by the general public as merely a reaction to social pressures about food and body image. Or, it is assumed the patient is probably just victim of exposure to a sport or industry that pressures people to maintain low body weights.

With steady diagnostic surge among males and the rise in increasingly younger AND older patients, the outdated image of the white, middle-to- upper class teenage female no longer works when we’re talking eating disorders.

Incredibly complicated diseases, most recent research suggests eating disorders actually result from a complex web of factors interplaying into the perfect storm. Genetics, social & familial factors, neurobiology, stress, and physical illness are just a few examples.

Eating disorders are further complicated by the fact that they are not just mental health issues. While the mental aspect is incredibly debilitating, the patient may also be suffering with complicated medical issues, which also need to be treated. In some cases, the medical issues may need to be the primary concern and treated first.

With their alarming mortality rate surpassing any other mental illness and half of the deaths resulting from medical complications, acute attention must be paid to each patient’s medical stability. Stereotypic images of stick thin, media-hyped models like “Twiggy” and “Kate Moss” along with assumptions of “teenage angst” leave many doctors overlooking the severity of a patient’s physical condition. Surmising everything as a routine “phase” can lead to failure of thoroughly examining co-occurring or underlying medical complications like gastroperesis, a condition where food is slow to leave the stomach.

Image of a woman holding her stomach

Though still underfunded, eating disorder research continues to progress every month. We now know gastrointestinal distress commonly correlates with eating disorders. So far, though, it is assumed that the eating disorder causes the digestive distress.

While some cases may be logically explained by a history of prolonged disordered eating, what if this is the root factor issue for others?

GI issues, such as gastroparesis, GERD, and colonic issues, can actually pose a close presentation to anorexia or bulimia when people begin to fear food and the discomforts of digestion. I’m left wondering how often digestive disorders are assumed to be eating disorders and misdiagnosed. Including the diagnosis of a mental illness in one’s chart changes the course of the medical care one receives and should be decided with thorough consideration.

Patients with core digestive issues are at risk of being treated improperly by the mental health system. The primary diagnosis as eating disorder sends the patient down the path of behavioral and mental health based care, where actual “true GI issues” are often minimized or ignored. Because of the “eating disorder” diagnosis, the patient is assumed to be fabricating the distress to get out of eating. Other times, the facility is just ill-equipped and inexperienced at managing the patient’s particular physical issues.

I know someone suffering with GERD and gastroparesis, who was misdiagnosed in the beginning of her illness. It is possible her initial symptoms could have been controlled with prescription medication. Almost a decade after “x” number of eating disorder program admissions, for an eating disorder she doesn’t think she even had to begin with, she now has to have a feeding tube and possibly additional surgeries.

Thousands of dollars have been spent on “conventional eating disorder treatment centers” that repeatedly missed the target. It also seemed to introduce her to a culture of “ED” that she never knew existed before. While rare, it is almost as though she learned how to have an actual DSM-V eating disorder by being in the wrong level of care.

Where do we go from here?

First, we need to continue to push for research funding toward eating disorders in general. For example, The NIH has allocated only $1.20 in research funding per affected eating disorder patient, compared to $159.00 per affected individual for schizophrenia, less than 1%.

Following suit with recent research data, eating disorders and feeding disorders have been coupled together in DSM-V. For example, anorexia and avoidant/restrictive food intake disorder are in the same category. Evolutions in eating disorder diagnosis have occurred in each of the most recent revisions to the DSM. It seems logical that some digestive and gastrointestinal disorders may also impact food behaviors that result in weight changes, food intolerances, preoccupation with food, and body image distress.

Physicians need to be mindful of this possibility as many of these same complaints come from patients with eating disorders, blurring the diagnostic lines leading to possible confusion and diagnostic error.

In the case where both digestive issues and eating disorder issues are present, individualized care is absolutely vital. Special accommodations not normally thought of as acceptable by eating disorder programs may be necessary, such as supporting a dairy-free or gluten-free diet.

If treatment providers could approach each patient as if they were assessing an eating disorder for the first time, fewer assumptions would cloud their ability to make a complete and thorough assessment.

Editor’s response from Mirasol ED Recovery Blog  Publishing Editor:

My first read through of Faith’s blog sent chills down my spine. I had to include my response because only in the last couple of months have I connected the dots between my own eating disorder and digestive distress.

I have high functioning autism traits and am easily fixated. I always had a heightened interest in food. I loved to play restaurant, make mud pies, and even had a toy grocery cart full of plastic food.

I also had a lot of extreme food dislikes and food preferences.

Eating is a multisensory experience, from the taste, texture, temperature, and even the sound of eating.

My sensory issues probably contributed a bit to my lengthy dislike list as a child, but I now wonder how much of this was also my body’s intuition telling me to stay away from foods that were causing physical distress and discomfort! In fact, it’s taken me several years of experimentation to find food combinations that work best for me. Though completely balanced with ample variety and nutrient content, most non-integrative treatment centers would consider my eating preferences eating disordered. Looking back, many of my “odd” food preferences were things that were naturally soothing to my digestion.

Basically, I’ve always had food stuff, eating disorder or not. Laxative, suppository, and enema abuse presented as my first clinically detectable eating disorder behavior, which all started at age 10. After having to receive an enema for severe constipation due to IBS, I was instantly hooked on the sense of relief from having a cleared out colon after such prolonged
discomfort.

This also happens to be the age when I developed suicidal ideation that eventually became chronic suicidal obsession. Stress and anxiety attacks usually correlated with more IBS flares and spasms. Of course prolonged laxative abuse only exacerbated the GI distress.

A a lot of factors merged together to create grounds for my perfect storm. In addition to depression, autism, and gastrointestinal distress, I also felt the social pressures to be thin. I was bullied for many things, including being chubby.  Perfectionistic in nature, I once checked out all of the eating disorders books available at the school library. I have an innate drive to be good at whatever I do, and the eating disorder was no exception. I became especially pre-occupied with becoming emaciated, which only worsened after my first inpatient stay, further triggered by exposure to severely ill patients. I didn’t openly admit this at the time but I also adopted a lot of ED rituals out of desire for belonging in the ED community. Socially awkward, I desperately needed to fit in somewhere. I definitely didn’t fit in at school or home.

Eventually, and it actually didn’t take long, the eating disorder became my entire world.

It leaves me wondering how the course of my life may have unfolded had my ASD and gastrointestinal issues been diagnosed when I was a tender ten.

When I was in treatment, I always complained to treatment providers of distracting sensitivity to my digestive track while following prescribed meal plans. I routinely experienced bloating, pain, constipation, diarrhea, and even hemorrhoids. Without exception, my voice was always dismissed as eating disordered thinking or ordinary body image related distress.

Digestive Disorder? Eating Disorder? Both? Great topic, Faith!

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