Everything You Thought You Knew about Addiction is Wrong

Brilliant! Unfortunately the solution can't be only individual or familial - it has to be political and cultural as well - but the message and learnings here are clear: the opposite of addiction is attachment.

http://www.ted.com/talks/johann_hari_everything_you_think_you_know_about_addiction_is_wrong

Childhood Trauma linked to Obesity and Illness throughout the Lifespan

Check out this amazing slideshow by Kathleen Kendall-Tackett about the links among childhood trauma, race, size, and socioeconomic discrimination,  and later physical illness, sleep disturbances, depression and obesity. This goes beyond the ACE studies and to look at all forms of stress/trauma including cultural ones. The worse the developmental trauma (this includes poverty and social discrimination), the greater the impact on physical and mental health, insulin resistance and obesity. Time to stop blaming the survivors and start challenging the causes. 

Lesser Known Causes of Obesity

We hear it in the news every day.  There is an obesity epidemic.  We are obese.  We just keep getting fatter and fatter.  

Who's responsible?  We must find someone to blame.  Why not blame the fat people?  Many people in Western society seem to have opted for distancing ourselves from the intolerable and projecting it onto “fat” and "fat people".  Our society's rage against fat as sin today may be comparable to the Victorian attitude about sex. Our desperation to avoid the stigma of fat is reflected in how we spend our money. 

In 2012 in the U.S. alone, the weight-loss industry raked in $61 billion on weight loss foods, food replacement products (i.e. Jenny Craig, Weight Watchers), books, surgeries, diet programmes, and diet supplements (in 1980 that number was $10 billion). 

After all, we can't control our age, our height, our colour, our socioeconomic status at birth, our parentage, our increasingly poisonous environment - we need something to claim control over - right?  If we can't control our body weight, there's no hope for us - right?  Wrong.

Obese people have been found to expend less energy while sleeping and resting than those who are not obese, making it easier to gain weight on lower caloric intake than those with higher resting energy expenditure rates:

"Resting energy expenditure (REE) was investigated by indirect calorimetry in relation to body composition and to different degrees of obesity in order to assess if a defective energy expenditure contributes to extra body fat accumulation …. The analysis showed a negative impact of obesity on REE beyond body composition variables."  (⁶Verga, p. 47)

Recent research by 12 Dallman suggests that high levels of stress over a long period of time (such as those caused poverty, chronic trauma and childhood abuse) can create changes in the brain that causes the body to redistribute its fat stores to the abdominal area and increases sucrose (sweets) appetite. 

Pagato, et al, 2012 observed that

• PTSD alters functioning of the HPA axis, which regulates cortisol secretion Cortisol hypothesized to promote obesity
• Cortisol secretion linked to stress-related weight gain
• People with PTSD have lower circulating cortisol relative to healthy controls

Ironically, the stigma from being fat, especially as a child, and the consequent vulnerability to ongoing bullying and abuse by peers can set this viscous cycle in motion or exacerbate it early on.

Additional causes of obesity unrelated to compulsive eating were also found by studies from the ⁷National Institutes for Health, and by ⁴Heitmann.  Obesity has been shown to have a significant genetic component according to cross-sectional twin and family studies done by ²Coady. And this genetic component is compounded by the tendency of obese people to mate with each other, as they are often excluded from mainstream dating circles.  From  ³Hebebrand:

"Our results indicate that assortative mating is common among parents of extremely obese children and adolescents, ascertained between 1995 and 1997. In addition, the parental loading on the tenth decile is most prominent for the most obese children."  (p. 345)

Major Cause of Obesity Epidemic: Weight-Loss Attempts

• Research on 17,000 children showed that twins who embarked on one intentional weight loss episode were two to three times more likely to become overweight compared to their non-dieting twin counterpart. Furthermore, the risk of becoming overweight increased in a dose-dependent manner, with each dieting episode. #1

• A 1999 report on 4,193 women and 3,536 men participating in the Finnish Twin Cohort Study revealed that dieters were several times more likely than non-dieters to experience major weight gain (more than 22 pounds) during a follow-up lasting 15 years. (pp.31) #2

#1. Alison E. Field, S. Bryn Austin, C. Barr Taylor, Susan Malspeis, Bernard Rosner (2003)

#2. Korkelia, M., A Rissanen, J Kaprio, TIA Sorensen, & M Koskenvuo (1999)

According to a 2007 Meta-Study (a study of 31 other studies, internationally)

• Diets do lead to short-term weight loss, on average of 5%–10% of the person's body weight

• These losses are not maintained

• The more time that elapses between the end of a diet and the follow-up, the more weight is regained.

• Among patients who were followed for two or more years, 83% gained back more weight than they lost

• In studies with the longest follow-up times (of four or five years post-diet), the weight regain trajectories continued to increase suggesting that if participants were followed for even longer, their weight would continue to increase. #3

#3 Mann, T., Tomiyama, AJ, Westling,E, Lew, AM, Samuels, B. (2007) Medicare’s Search for Effective Obesity Treatments in American Psychologist Vol. 62, No. 3, 220–233

Putting people on caloric restriction regimens is bound to fail, as their bodies will tell them that they are not getting enough to eat (they will have a constant nagging hunger that will only ease up when they eat).  Checking for medications that cause weight gain, educating about food additives such as trans fatty acids or trans-fats, explaining about the connections between genes, stress, childhood abuse and body size to de-stigmatise, and encouraging an increase in activity levels with guidance on how to incorporate regular exercise into daily routines is the only humane prescription for obesity when it is not related to overeating.

References:
²Coady, S.A., Jaquish, C.E., Fabsitz, R.R., Larson, M.G., Cupples, L.A., & Myers, R.H. (2002). Genetic variability of adult body mass index: a longitudinal assessment in Framingham families. Obesity Research, 10, 675-81.
^1aColditz, G.A. (1992). Economic costs of obesity. American Journal of Clinical Nutrition, 55, 503-507.
¹²Dallman, M.F., Pecorary, N., Akana, S.F., la Fleur, S.E., Gomez, F., houshyar, H., Bell, M.E., Bhatnagar, S., Laugero, K.D., and Manalo, S. (2003) Chronic stress and obesity: A new view of "comfort food".  Proceedings of the National Academy of Sciences of the USA, 100/20, 11696-1170^1
11 Trust for America's Health Report. (2005). F as in Fat: How obesity policies are failing in America.
¹⁰Farley, Tom,  (2005). Prescription for a Healthy Nation : A New Approach to Improving Our Lives by Fixing Our Everyday World. Boston: Beacon Press
⁸Gallagher, D., Testolin, C., Heshka, S., & Heymsfield, S.B. (n.d.). Body mass index: Differential misclassification of under and over-fatness. New York City: Obesity Research Center, St.
³Hebebrand, J., Wulftange, H., Goerg, T., Ziegler, A., Hinney, A., Barth, N., Mayer, H., & Remschmidt, H. (2000). Epidemic obesity: are genetic factors involved via increased rates of assortative mating? International Journal of Obesity Related Metabolic Disorders, 24, 345-53
⁴Heitmann, B.L., Harris, J.R., Lissner, L., & Pedersen, N.L. (1999). Genetic effects on weight change and food intake in Swedish adult twins. American Journal of Clinical Nutrition, 69, 597-602.
^1bMetropolitan Life Insurance Company (1983). Metropolitan height and weight tables. New York: Author.
⁷National Institutes for Health (2001). Understanding adult obesity. NIH Publication No. 01-3680. Washington, DC: U.S. Government Printing Office.
⁵U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (1996). Physical activity and health: A report of the surgeon general. Washington, DC: U.S. Government Printing Office.
⁶Verga, S, Buscemi, S., & Caimi, G. (1994). Resting energy expenditure and body composition in morbidly obese, obese and control subjects. Acta Diabetologia, 31(1), 47-51.
 
  

Fight the Brain or Change the Brain

Recent research in neuroscience tells us what we had thought impossible is now possible. Early implicit (non-verbal bodily held) learning – the kind of learning that can also drive most forms of psychological distress, can actually be erased under the right circumstances.

First let’s take a look at what this means.

Implicit learning is laid down in the nervous system by early repetitive emotionally charged and/or traumatic experiences. As the child grows, it becomes linked to basic beliefs about the self.

Here are some common examples:

I am inherently bad/dirty/stupid/ugly…etc.

I can't depend on anybody - I have to do it all myself.

Love is dangerous/painful/violent/exploitive and it’s best to avoid and/or to just expect all relationships to be like that

Feelings are dangerous - it's best not to have any (or at least not to let them show).

To love is to be mistreated/to mistreat

If I try I will fail, so best not to try

Needing is wrong, dependence is wrong – it’s best not to have any needs

These kinds of basic self- beliefs, or “scripts” can drive large areas of life. Because they are laid down implicitly, they tend to be immune to logical questions or arguments. 

This is because they are actually held in the body and nervous system rather than in the “thinking brain” and are faster and more automatic than logical thinking because they were originally somehow tied in to perceptions around survival (the messages may have originally been communicated by needed childhood caregivers, for example).

Fighting the Brain

Since most forms of psychotherapy are verbal, we have believed up until recently that the only way to cope with this kind of dysfunctional learning was to challenge the logic of such beliefs and set up competing neural pathways that would eventually, through a great deal of practice, become available as the “preferred” neural pathway.  This is the foundation of much of cognitive and behavioural psychology.

Nevertheless, competing new beliefs learned logically in adulthood can never completely replace implicitly held beliefs laid down and reinforced in childhood, and so relapse must be constantly guarded against, especially when something associated with the earlier learning reappears in the current environment (a"trigger" -  e.g. a boss or spouse implying the same message).

The most common way set up competing beliefs is via Cognitive Behavioural Therapy, whereby the dysfunctional beliefs are deliberately challenged with new thoughts and learnings which are then rehearsed in new behaviours repeatedly until the old beliefs lose their original power. Psychoanalytic or psychodynamic interpersonal therapies also challenge old implicit learning via the therapeutic relationship itself, whereby repetitive experiences of (hopefully!) non-exploitive, consistent, secure attachment with the therapist replace the old beliefs that were based on exploitive, inconsistent, insecure early attachments.  

Example:

CBT: Old implicit learning: “If I try I will fail, so best not to try” as applied to job hunting (for example). CBT points out the illogic of the assumptions and encourages rehearsing new alternate thoughts such as “if I try, even if I fail, I can still learn something of value – and sometimes I will succeed.”  Behavioural rehearsal might involve the assignment of applying for xyz jobs and keeping track of any learnings or successes to challenge the old learning. Through  repetitive practice the new learning creates a new available pathway that offers an alternative to the older learning – however it doesn't replace it, and confirmations of the old learning (such as failures that don’t result in positive learnings) can always send the person back to the old learning.  I call this approach “fighting the brain.”

Changing the Brain

In their recent book, Ecker, Ticic and Hulley (2012) present the basic components necessary to erase dysfunctional implicit learning, and then examine numerous contemporary forms of psychotherapy to determine which types incorporate these components. Not surprisingly, most do. However, some forms of therapy are more efficient, systematic, and deliberate in their use of these components than others, making for a considerable difference in the likelihood of success and the length of time it takes to get there. The components are as follows:

1.       Identify and access the memories of the original experiences that laid down the implicit dysfunctional self-beliefs

2.       Retrieve the accompanying  learning simultaneously with the memories:  both emotional and  schematic

3.      At the same time as the feelings, memories and beliefs are retrieved, provide repeated experiential disconfirmation of the dysfunctional learning

a.      Disconfirmation must “make sense” emotionally

b.      Original learning plus disconfirmation must be repeatedly paired within a 5 hour window

c.       After 5 hours a built-in mechanism re-locks the synapses

Each of these steps correspond precisely to phases 4 through 7 desensitisation stage of the standard 8 phase EMDR protocol, even though EMDR was developed 20 years prior to the current confirming discoveries in neuroscience.

My main concern here is that this “new” approach, even if applied systematically, will probably have similar limitations and cause similar results to those that have emerged from years of research and practice in EMDR. It will seem miraculous when applied to dysfunctional learning caused by a single –incident trauma; but it won’t be so simple when dealing with the many ego states that develop in response to repeated developmental trauma and dysfunctional implicit learning.

When ego states are split off by trauma, they are sometimes unable to “share” information from one state to another. This is what enables many survivors of horrific experiences to function at a much higher level than they might otherwise if the full impact of the traumas were experienced by all parts of self equally. This also means that it is essential, when applying the above steps, to make sure that the ego states that hold the implicit dysfunctional learning are the same ego states that are exposed to the disconfirmation of that learning.

I think we will find, as we did with EMDR, that more complex forms of traumatic implicit learning are most effectively addressed with a combination of trauma processing (or Implicit memory “erasure”), somatic mindfulness, and ego state work.

References:

Ecker. B, Ticic , R, & Hulley, L. (2012). Unlocking the Emotional Brain. New York: Routelege

Shapiro, F, & Forrest, MS, (2004) EMDR: The Breakthrough Therapy for Anxiety, Stress and Trauma. New York: BasicBooks

Tronson, N. C.; Taylor, J. R. (2007). Molecular mechanisms of memory reconsolidation. Nature Reviews Neuroscience 8 (4): 262–275