Professionals: How to help your clients reduce stress-induced eating

Professionals: How to help your clients reduce stress-induced eating

Some clients and patients (I’ll just use “clients” from now on to cover both) find that they turn to food to deal with stress even though they don’t want to. This can mean that they can stick to their weight loss goals when life is smooth, but when their stress levels rise, so does their weight. Stress-related eating is one of many types of emotional eating and in this article, I’ll outline a way of discussing stress with your clients so that they can experiment with non-food ways of dealing with stress. This won’t work for everyone (nothing does) but people who know that stress is an issue for them will welcome the chance to discuss it in a way that offers hope.

My hope in this article is to think about stress in a way that incorporates people who are in a period of acute stress and those for whom chronic stress has been the norm. You don’t need to know about the reasons for the stress with this approach – the focus is on tuning in to the person’s inner physical experience right now.

Stress affects us biologically (of course)

Stress affects people differently – some lose their appetite whilst others find themselves eating more. Neuroscientist Dr Nicole Avena says that this difference may result from a combination of your background level of chronic stress, your biological predisposition (eg your hypothalamic-pituitary-adrenal axis responsiveness), and how prone you are to dysregulated eating. Here I’ll focus just on those clients who eat more when stressed. Key points Avena makes about stress-related eating for this group of people are:

  • Stress-induced increases in cortisol are thought to increase appetite
  • Chronic stress appears to heighten sensitivity of the reward centre and increase appetitive drive for palatable food
  • When you combine chronic stress with repeated consumption of highly palatable foods, the drive to eat palatable food becomes a habit

 

Stress affects us psychologically (of course)

According to Professor Walter Mischel, acute uncontrollable stress, even if it’s quite mild, can cause a rapid and dramatic loss of prefrontal cognitive abilities. The very mental function you need if you’re trying to change how you eat (pre-frontal control), is suddenly in short supply and for many clients who struggle with their weight, stress is often an integral part of their lives.

Taken together these two points mean that under stress, particularly if your client has a history of having chronic stress in their life, their biological system will be driving them to seek out palatable foods whilst their inhibitory self-control may have deserted them. So stress is a serious issue when it comes to changing how your clients eat.

 

A new way of thinking about stress

In this article I want to introduce you to a way of thinking about how our nervous systems function, which provides a simple-to-understand model for your clients. Importantly this model helps each individual client discover how to regulate their own internal reactions to stress, through simple strategies. As ever, nothing works for everyone, but many of your clients may find this approach useful in understanding and managing stress. This model comes from the Polyvagal Theory of Dr Steven Porges and it has been translated helpfully into an excellent book for clinicians by Deb Dana. First I’ll outline this for you, and then suggest how you can boil it down to one simple idea to explain to your clients.

 

Stress happens when our nervous system moves out of its comfortable range

Continually, everyday experiences are received by our nervous system and read as safe, dangerous or life-threatening. Our Autonomic (self-governing) Nervous System (ANS) operates automatically to manage risk and seek safety, moment to moment. There is nothing in human functioning that is more basic than safety and this system continually scans the environment and scans within our bodies to check for any potential threat. Thanks to the system being controlled by deeper unconscious levels of the brain, we don’t have to pay constant attention to it, so we’re able to do our job, plan our next holiday or follow the plot of our favourite soap opera. Being able to engage with interesting activities and other people is a sign that our nervous system is in its comfortable range.

But when we move out of our comfort zone, into stress or danger, our nervous system will register the need to take regulatory action. Any sense of danger (even if it’s not real) triggers us out of this and into sympathetic activation, ready to take action. First, the Sympathetic Adrenal Medullary (SAM) system triggers a super-fast surge of adrenaline which then falls back down again and this is followed by a slower release of cortisol by the Hypothalamic Pituitary Adrenal (HPA) system. Together these systems produce the bodily and behavioural responses that allow us to resolve the stress. If the stress continues and is not resolvable, we enter a state of shut-down or collapse.

Many people are able to move back in to the comfortable state from over-or under-stimulation without eating, but many others have discovered that food provides the best solution to moving away from these aversive internal states.

 

The ANS is made up of two branches: Sympathetic and Parasympathetic

  • The Sympathetic nervous system (myelinated) originates in the middle part of spinal cord and
    • Responds to cues of danger
    • Triggers adrenaline release
    • “fight or flight” with too much energy in the system – overstimulated
    • We feel on edge/ alert/ uneasy and our brain will be trying to work out why, so our attention narrows to focus on the potential source of the threat

 

The Parasympathetic nervous system involves two particular pathways within the vagus nerve (ventral and dorsal) and travels from the brain stem upwards to connect with nerves in neck, throat, eyes and ears and downwards through lungs, heart, diaphragm and stomach

  • Ventral vagal pathway (myelinated, unique to mammals)
    • Responds to cues of safety
    • Associated with activation of the Social Engagement System
    • “rest and digest”
    • We feel engaged in the world and with others and can think clearly and calmly, able to see the bigger picture
  • Dorsal vagal pathway (ancient, unmyelinated, vertebrate)
    • Responds to cues of extreme or inescapable danger
    • Takes us away from social engagement into immobilisation/ numbness/ freeze state
    • “fright” or “freeze”
    • We feel shut down physically and emotionally alone and unable to think clearly

 

As you can see, the state where we function best is the ventral vagal state of being relaxed and able to engage with the world and other people. Your clients don’t need all the above information, just a summary of it which reflects the fact that stress-related eating is an attempt to bring their nervous system back into a comfortable state. When we eat to calm stress, we are in effect trying to reduce the over- or under-stimulation of the moment.

For some people “under-stimulated” would simply mean a state of boredom, and does not mean that they are in a shutdown state, but for people who have experienced extreme or inescapable danger in their lives, staying out of this state of collapse will involve more than just finding something to do. If your role with your client is not about treatment of past trauma, just being aware that a client might be dealing with overwhelming internal states and framing these as normal adaptations may help them learn new ways of moving out of those states without food. There is always a risk that if you use language like “under-stimulated”, the person may feel you have entirely missed the point, so if they have their own name for a state which leads them to eat, go with that.

The Goldilocks Guide  

A shorthand way for your client to learn how to stop stress-related eating is to start by learning to label their own internal state as “over-stimulated”, “under-stimulated” or “just right”. Just like the girl in the fairy tale with the bears and the porridge, your client’s task is first to notice which of these three states of nervous stimulation they are in at the point they think of reaching for food. If your client has entered either Sympathetic over-stimulated or dorsal vagal collapse, they need to find things that can help bring them back comfortably into the ventral vagal state. Deb Dana calls this “befriending the nervous system” and for many of us, it’s a revelation to start listening to our bodies and what they are trying to tell us.

 

Practical strategies to return to the ventral vagal “just right” state

Things that can help your client come back into the ventral vagal state from the sympathetic over-stimulated state are those that gently discharge the excess energy. Through trial-and-error they can find which work best for them using this list as a starting point of ideas:

  • Slow down your breathing, lengthening the out-breath and creating resistance by pursing your lips and pushing the breath out. Notice what feels comfortable and stay with that
  • Blow streams of bubbles
  • Play a kazoo or a breath-powered musical instrument
  • Connect with a pet – stroking or holding an animal can be very calming
  • If you can get outside, try running or energetic walking
  • Write or draw about this state and how it feels
  • Create a playlist of songs that you associate with feeling socially connected, calm or joyful and sing or hum along to them
  • Notice your temperature – are you too hot? If so, find cooling things to hold or notice that as you breathe, your in-breath is taking in cool air and your out-breath is releasing heat from your body
  • Text a supportive friend

 

Things that help your client come back from dorsal vagal collapse involve a gentle return of energy. Again, suggest that they use trial-and-error to find which techniques work best for them using this list as a starting point of ideas:

  • Regulate your breathing so that your in-breath and out-breath are about the same length. Notice that your in-breath is taking oxygen and energy into your body
  • Connect with a pet – stroking or talking to a pet may help you feel more connected
  • Small movements or slow walking
  • Write or draw about this state and how it feels
  • Create a playlist of songs that you associate with feeling socially connected, calm or joyful and sing or hum along to them
  • Sit on a therapy ball and focus on staying steady. This requires micro-movements which can keep enough energy moving in your system to help you stay present
  • Notice your temperature – do you need more warmth? If so, hold a hot drink or a warm pack, have a hot shower or bath or wrap up in a warm blanket
  • Collect positive messages, cards and letters and read them over, or text a supportive friend

 

Summary

Food can stimulate or calm us physically, whether from what is in the food, or the act of chewing or biting. There’s nothing wrong with using food to regulate ourselves, but if your client is turning to food because they haven’t found anything else that helps, they may find it really helpful to have some understanding of how they are trying to move from an aversive internal state (sympathetic or dorsal vagal) towards a more comfortable ventral vagal state in which they can engage with the world and other people. The first step is to explain the Goldilocks Guide idea to help your client monitor whether, when they are reaching for food when stressed, they are over- or under-stimulated. Then teaching them simple strategies to turn to as an alternative at moments of stress means that they have an option. If it doesn’t work, they can experiment with other ideas.

 

References

Avena, N (2015) Hedonic Eating. Oxford University Press.

Dana, D (2018) The Polyvagal Theory in Therapy. Norton Books

Mischel, W (2014) The Marshmallow Test. Corgi Books

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If you’d like to come to one of my workshops for professionals on the psychology of how to help your clients lose weight, here are details of upcoming events

 

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