For many patients with eating disorders, binges and purges typically follow negative emotions such as anxiety, sadness, anger, or boredom. Exercising a delay means, upon noticing the surge in negative emotion, to try to stop, wait, and manage that emotion through another means. Delays work best when paired with an alternative: an activity that takes the place of bingeing or purging. These tools, which stem from cognitive-behavioral therapy (CBT), are also a component of dialectical behavior therapy (DBT) commonly referred to as distress tolerance. You may also think of alternatives as coping skills. Many patients with eating disorders can benefit from increasing their repertoire of coping skills. It is always beneficial to have more tools in one’s toolbox for coping with distress. Have you ever had an urge to binge or purge that was unexpectedly interrupted so that you could not carry out the intended behavior? Maybe you had planned a binge but then were interrupted by the arrival of a family member? Or maybe you intended to purge, but could not due to unexpected lack of privacy. If you had this experience, did you find that the urge to binge or purge grew increasingly stronger and persisted indefinitely? More likely, you found that the urge eventually subsided even when you didn’t carry out the behavior. If so, you have already had experiences that you will be able to reference to help you develop skills for reducing bingeing and purging. If not, don’t worry; they can still be learned with practice.
Practicing Delays
Urges and anxiety commonly mount and then subside like a bell curve. During the time they are mounting, they often feel like they will increase indefinitely. This is an illusion: when time elapses, these feelings and urges usually gradually subside on their own. The person who binges or purges, however, tends to surrender to their behavior at the point at which they feel most distressed (near the apex of the curve), and immediately starts to feel some brief relief from anxiety. This experience prevents them from discovering that the anxiety and urge would have subsided on its own in the absence of the binge or purge. It may even feel as though the behavior is out of one’s control because of how automatic the response becomes. Behavioral reinforcement then leads the person to repeat these behaviors whenever negative emotions or urges threaten. They become habitual. Imagine by way of contrast that every time you had an intense negative emotion or strong urge to binge or purge, that you stood on your head. You would probably love standing on your head because it would always be associated with a drop in anxiety! A further complication is that after bingeing and/or purging you may feel guilt, shame, or self-contempt. This is one of the problems with maladaptive coping skills; they may provide some temporary relief, but they usually make you feel worse in the long run. Feeling bad may increase your anxiety to the level it was previously making you vulnerable to future binges and purges, and so the cycle repeats.
Practicing Alternatives
It is helpful to develop a list of alternative behaviors to binge eating and purging. These alternative behaviors can range from distracting to actively soothing. It is helpful to have a varied list of activities so that you have options to consider depending on the situation, where you are, the time of day, and so on. For example, if it is the middle of the night and calling friends is on your list, friends may not be available to call; if you are at work, taking a shower will likely not be an option. For people who purge, painting their nails is often a good option because it is not physically possible to purge at the same time. Here are some alternative behaviors that some patients with eating disorders have found helpful:
Calling a friendListening to musicTaking a bath or showerPainting your nailsLighting a scented candleKnitting, crocheting, or doing beadworkPainting on canvasListening to a guided meditationColoring in a coloring bookPinning on PinterestPlaying video gamesDoing puzzles – crosswords, sudoku, or jigsawGoing for a walkPlaying with a petCleaning the bathroomPlaying with silly puttyDoing simple relaxing yoga posesPutting on essential oils or scented lotion
How to Implement
Rather than trying to prevent a binge entirely, some people like the idea of delaying the binge for a specific period of time and then retaining the option to still binge if they want following the delay. Practice delaying the binge (or purge) for a specific period of time, i.e. two minutes. Set a timer. Do one of the above activities for two minutes and then check back in. Over time you can practice delaying the urges for increasingly longer periods of time. By the time that you can delay the urge for 20 minutes, you will likely find that the urge has entirely passed. Practice delaying the binge at least 15 minutes with the goal of preventing the binge entirely and substituting an alternative behavior whenever you have an urge. Attempt to substitute one alternative activity. If that activity does not seem to be working, try another from your list. Using delays and alternatives takes practice. Because the binge and purge behavior is something you have been doing for a while, it is ingrained. Using delays and alternatives will take a lot of effort at first. It is like building a muscle. Every time you stand up to an urge and don’t give in, even if only for a few minutes, you are building the muscle to tolerate distress. Over time, as the muscle gets stronger, standing up to urges will become easier, and eventually automatic.
Resources for Developing Coping Skills
Here are some additional resources you might find useful as you work to improve your coping skills. Facing Your Feelings: Written by the Center for Clinical Interventions, this four-module free online workbook teaches strategies for managing distress. 50 Ways to Soothe Yourself Without Food: This book, by Susan Albers, Psy.D, draws upon a variety of strategies to cope with emotional eating. The techniques are divided into five sections including:
Implementing mindful meditation techniquesChanging your thoughts/changing your eatingExperiencing soothing sensationsSoothing yourself with distractionsCalming yourself with emotional relationships
Secret Garden: An Inky Treasure Hunt and Coloring Book: This coloring book, and other similar coloring books for adults, can be a good resource for coping.
