Can you relate to that hypercritical voice in your head? You know, the one that pops up at the most inconvenient moments to remind you of past failures and the likelihood of future ones? That perfectionistic voice that is never satisfied, never content, always pushing for an unachievable standard, or coaxing you to quit before you fail. In someone with an eating disorder, that inner critic carries a megaphone and the voice of the eating disorder, and the inner critic is often the same.
When I first sought out Mindful Self-Compassion (MSC), it was to confront my inner critic. I had been practicing mindfulness for years, and one of the benefits was a greater awareness of the impact of my hypercritical voice. With awareness, one can make different choices, so I sought tools to shift my critical self-talk. I discovered Kristin Neff and Christopher Germer’s Mindful Self-Compassion work and began what will be a lifelong practice. My practice inspired my decision to become an MSC teacher.
According to research Mindful Self-Compassion participants experienced lower incidences of anxiety, depression, and emotional avoidance and greater social connection and sense of well-being. (Neff, K and Germer, C, 2012). Self-compassion practices also significantly reduce body dissatisfaction (Albertson, E., Neff, K. and Dill-Shakelford, K, 2014). The gains participants experienced from the MSC class were still present one year after taking the course. MSC practices provide supportive tools to combat perfectionism and an unhealthy body image while building emotional resilience and improved well-being.
Below are some of the tools I incorporate in my work with clients struggling with eating disorders, disordered eating, and poor body image. While I implement them in clinical practice, they are also easy to learn and apply on your own or through the many resources available through The Center for Mindful Self-Compassion.
3 MSC Tools for ED treatment
- Soothing Touch, combined with the Self-Compassion Break
These practices are accessible tools for self-soothing and can be done anywhere and anytime. These practices, individually and in combination, can help calm the amygdala by activating something called the mammalian caregiving system.
As humans, we are not born with the ability to walk, talk, or care for ourselves. Fortunately, we come equipped with a system to ensure that parents do not walk away from crying babies or eye-rolling teenagers. Imagine a child falls, skins his knee, and cries. The caregiver picks up the child, perhaps kisses the booboo and with a gentle voice says, “I know it hurts, it’s ok, you’re ok now.” Soothing Touch and gentle vocalizations activate the mammalian caregiving system, calming the amygdala (which is responsible for fight, flight, and freeze) and releasing Oxytocin in both the child and the caregiver, (Neff, K., n.d.)
The great news about the mammalian caregiving system is that one can activate the system for themselves when needed. Soothing Touch and gentle vocalizations for another have the same impact when directed toward oneself. In eating disorder treatment, this system can help with mealtime in early recovery as well as in learning to cope with difficult emotions. The purpose is not to make difficult emotions go away, but to make them easier to bear as they naturally dissipate.
Soothing Touch is the practice of having the patient close their eyes and follow along with a series of gestures. The goal is to tune into gestures that feel soothing to them. A partial list would include, holding your own hands, crossing your arms and rubbing in a gentle motion, placing one hand or both hands on the heart, one hand or both hands on the cheeks or one hand in a fist and rubbing the back of the fist with the other hand. The patient will choose which gesture feels soothing, or they may already have their own. For instance, some people with long hair find it soothing to run their fingers through their hair. Other patients might feel soothed, focusing on and rubbing a worry stone.
The Self-Compassion Break is broken down into three components that can be practiced in any order.
- Mindfulness: The first step is to recognize one is experiencing some form of struggle. That struggle might be emotional pain, physical pain, or the mental pain of rumination. Acknowledging the difficulty is the mindfulness step. In a compassionate tone, one might say, “this is scary, or this hurts, or even ouch.” The goal is to recognize and validate the difficulty with a compassionate tone.
- Common Humanity: The second step is to remind oneself that everyone experiences suffering, hurt feelings, feeling inadequate, the imperfections of living a human life. Often one feels alone when suffering, but in reality, it is our imperfections and struggles that bind us most to one another.
- Self-Kindness: Finally, one offers kindness in the face of suffering through kind words and actions. Christopher Germer and Kristin Neff have called this the yin and yang of self-compassion. The yin describing kind words one says to oneself and the yang describing kind actions such as phoning a friend, taking a walk, or getting professional help.
In session, I teach these tools and encourage and model their use when uncomfortable emotions arise so patients can take these self-soothing tools with them.
- Developing a relationship with the inner critic and creating a compassionate voice
Patients often experience the hypercritical voice as their voice. By externalizing that voice, the patient can learn to question it and separate from it. Usually, I will invite a patient to create an image, how the critic might look and sound. I might ask where they first heard those messages as they sometimes come from someone in childhood. We will then discuss the motivation behind the critic. For instance, the goal of the critic might be protection, demanding perfection to protect against rejection. There is nothing wrong with wanting to avoid the pain of rejection, but the methods are destructive. If the patient identifies this voice as an abusive caregiver from childhood, then the inner critic may have no redeeming value.
Once we create a picture of the inner critic, we can move on to developing a compassionate voice. We might consider the opposite message, or perhaps how the patient might speak to a child they love in the same situation. If there is not a history of abuse, another option is to picture oneself as a child and speak the words the child needs to hear. One of my clients has a picture of themselves as an 8-year-old with face paint. Drawing that picture in the mind’s eye allows the patient to speak directly to that hurt part of themselves, offering themselves the kindness and compassion they need.
- Soles of the Feet
This mindfulness practice invites the meditator to focus attention on the soles of their feet, recognizing the sensations of the feet when moving and sitting still. The practice also offers the opportunity to express gratitude for all that the feet make possible. Like any meditation practice, soles of the feet use attention regulation to regulate emotions and relieve stress. For an eating disorder patient, this practice can also provide a safe and positive embodied experience. A pdf of this practice can is available on the practices page of The Center for Mindful Self-Compassion link below.
For a person with an eating disorder, shame, emotional pain, and perfectionism are frequent companions. Self-compassion offers an invitation to hold emotional, physical, and mental suffering gently, not to eliminate or avoid such experiences but to support yourself when going through them. Mindfulness helps one identify that perfectionist within who is vocalizing the inner critic. Developing a compassionate voice can help to change one’s relationship with oneself and gradually release the hold of the perfectionist.
While I use these tools in a clinical setting, I began the practice on my own with the help of a book and free recordings. The great news about these tools is how accessible they are. That said, a clinical environment or group setting such as the class I took and now teach provide the support most people need to incorporate self-compassion into daily life.
As a clinician treating eating disorders, I have found the most effective means for incorporating mindfulness and self-compassion into your treatment plan is to embody it for yourself. Research shows that self-compassion practices are a powerful tool for professional and non-professional caregivers to combat burnout. After all, as psychologist, mindfulness expert and author, Jack Kornfield says, “if your compassion does not include yourself, it is incomplete.
Recordings of these self-compassion practices and many others can are available on the website for the Center for Mindful Self Compassion at https://centerformsc.org/practice-msc/guided-meditations-and-exercises/.
About the author:
Cori Rosenthal is a licensed Marriage and Family Therapist and mindfulness and Mindful Self-Compassion educator in Santa Monica, California. She specializes in working with people who struggle with food and their bodies, codependency, anxiety, and depression, and runs a mindfulness and self-compassion group at Applied Treatment in Los Angeles. Additionally, Cori is a public speaker at professional events and conferences as well as in treatment centers and schools. She speaks about Mindful Self-Compassion, HAES, and Intuitive Eating for adolescents and adults.
Cori takes an eclectic approach to therapy based on the unique needs of each client. When applicable, she incorporates Brainspotting, Trauma Resiliency Model (TRM), DBT Skills and Pia Melody’s Post Induction Therapy Model, as well as mindfulness and self-compassion practices in her work with adults, adolescents, and groups. For more information about Cori’s practice, visit www.CoriRosenthal.com
References:
Kristin Neff, “The Physiology of Self-Compassion,” https://self-compassion.org/the-physiology-of-self-compassion/ n.d.
Kristin Neff and Christopher Germer, “A Pilot Study and Randomized Controlled Trial of the Mindful Self-CompassionProgram” https://mindbody.co.il/wp-content/uploads/2019/03/Neff-Germer-MSC-RCT-2012.pdf
Ellen R. Albertson & Kristin D. Neff & Karen E. Dill-Shackleford, “Self-Compassion and Body Dissatisfaction in Women: A Randomized Controlled Trial of a Brief Meditation Intervention,” Springer Science+Business Media New York 2014
