Meal Experientials
for Eating Disorders:
The Method to the Madness
Objectives
• Identify and implement meal experientials with any client
struggling with any type of eating disorder and help them
break down barriers they perceive in a social meal
setting.
• Use a protocol for experientials that include: pre/post meal
goals; processing tools; and a list of creative ideas that
challenge, yet support clients to manage “real world” meal
settings through a systematic-approach.
• Effectively and respectfully monitor eating disorder behaviors
that can interfere with an individual’s success in the
experiential or in the group as a whole.
Exposure Therapy: The Experiential
• Ellyn Satter, MS, RD, LCSW, BCD
– Eating Competence Model – “being positive,
comfortable and flexible with eating as well as matterof-fact and reliable about getting enough to eat of
enjoyable and nourishing food.”
• Exposure Therapy- “the process of habituation,
the natural neurologically-based tendency to get
used to things to which you are exposed for a
long time. “
What is Normal Eating?
• Normal eating is going to the table hungry and eating until
you are satisfied. It is being able to choose food you like
and eat it and truly get enough of it -not just stop eating
because you think you should.
• Normal eating is being able to give some thought to your
food selection so you get nutritious food, but not being so
wary and restrictive that you miss out on enjoyable food.
• Normal eating is giving yourself permission to eat
sometimes because you are happy, sad or bored, or just
because it feels good.
What is Normal Eating? (cont’d)
• Normal eating is mostly three meals a day, or four or five, or it can be
choosing to munch along the way. It is leaving some cookies on the plate
because you know you can have some again tomorrow, or it is eating more
now because they taste so wonderful.
• Normal eating is overeating at times, feeling stuffed and uncomfortable.
And it can be undereating at times and wishing you had more.
• Normal eating is trusting your body to make up for your mistakes in eating.
Normal eating takes up some of your time and attention, but keeps its
place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your
schedule, your proximity to food and your feelings.
Reference: Ellyn Satter, MS, RD, LCSW, BCD
Meal Experientials and levels of care
• Guidelines/ideas discussed could be
implemented at any level
• InPatient – All meals/snacks provided by facility.
Improved weight restoration with no choices.
• PHP – Increased exposure to meal planning,
preparation, serving/eating group-prepared food
and occasional restaurant outings
Meal Experientials and levels of care
• IOP – Emphasis on integrating into “real
world” scenarios
– Restaurant outings
– Dessert outings
– Catered meals
– Nutrition education incorporated
– Flexibility of meal plan and honoring appetite in
any setting
Staff Responsibilities:
Meal Experientials
•
•
•
•
•
Be appropriately positive and enthusiastic
Maintain dignity of individuals
Use appropriate level of support needed by client
Be a role model during meals – all foods fit (1/42)
Provide and teach accurate nutrition, health and
food information
• Honor “real” dislikes, allergies and dietary
preferences (i.e.; vegetarian)
Why have meal experientials?
• Create “real world” scenarios to build confidence and gain success
• Encourage and enable client to eat with friends/family and limit
social anxiety
• Practice ordering off a menu and making choices
• Learn “survival” skills during meal times
–
–
–
–
Engage in conversation
Use mindfulness techniques
Incorporate affirmations
Reach out for support if needed
Why have meal experientials?
• Practice listening to appetite
• Use substitution as needed
• Practice eating in a public setting and understand
what the eating disorder makes up about this
• Encourage surrender to experience
– Staff or peers might serve ct
Why have meal experientials?
• Practice meeting meal plan and body’s needs
with a restaurant style meal
• Promote spontaneity and flexibility –
relinquish control over food
• Creates opportunity to have a positive
experience with a food that may have
negative associations
“Rules” for experientials
• Minimal changes to item ordered only with approval
• Honor appetite and use containment of feelings/thoughts
• Water only and no refills – practice using voice
• Ct must use the restroom prior to meal and not again until
break
• No entrée salads – sides permitted, no dressing on the side
“Rules” for experientials
• Use condiments appropriately and in reasonable
amounts
• Dessert consumption – 50%-100% - listen to
hunger/fullness and appetite (Ct may have individual
goals)
• Use voice to ask questions about food items if needed
• EDBx’s monitored and handled with dignity
Meal Experiential Agenda
• 5p-530p – Introduction, review purpose and benefits of
meal experiential; fill out goals sheet – goals sheets
reviewed by dietitians
• 530p-630p – catered meal and dessert OR
• 530p-700p – dining out timeframe
• 700p-830p – after meal processing, nutrition
lecture/activity if dining in, final group processing
for support
Pre-meal goals (see handout)
•
Hunger/fullness level and meal plan goals
•
Struggles that may interfere with meal
•
How does your ED want you to handle this struggle?
•
How would your wise mind reframe it?
•
Specific goals that will help you be successful
•
Fears around the food or type of meal
•
What tools can you use to cope more appropriately?
•
What type of support would you like to have?
Meal Experiential Goal Worksheet
Name: ____________________________________
Date: _____________________________________
Hunger going into meal on our scale of 1-10: _____
Meal Plan Exchanges for meal: Protein: _____
Grain: _____
Fruit: _____
Vegetable: _____
Fat: _____
What are you struggling with today or this week that may interfere with you being recovery focused for this
meal experiential? __________________________________________________________________________
__________________________________________________________________________________________
How does your ED want you to deal with this struggle? How can you use your wise mind to reframe your
thought process to be more recovery focused? ____________________________________ _______________
__________________________________________________________________________________________
List other goals for the meal:
1.
____________________________________________________________________________________
2.
____________________________________________________________________________________
3.
____________________________________________________________________________________
On a scale of 1-5, what is your readiness for the meal? (1=very ready; 5=not ready at all)
1
2
3
4
5
Why did you assess yourself at this number? _____________________________________________________
__________________________________________________________________________________________
What fears, if any, do you have about the meal or food? _______________________ _____________________
__________________________________________________________________________________________
What tools will you use to deal with any urges you might have? ______________________________________
__________________________________________________________________________________________
In what way can the group or dietitian support you during the meal? __________________________________
What days will you be here for the rest of the week? Thurs _____
Fri _____
First day next week? __ _______
Hunger/Fullness Scale
• “Perfect world”
• Emotional fullness
and emotional hunger
_______________________________________
1
2
3
4
5
6
7
8
9
10
Types of Meals & Experiences
• Ethnic meals – offer wide variety
– Mexican, English, Greek, American fast food, Italian,
Chinese
• Themes
– Holidays
• Examples: Thanksgiving, Christmas, Chanukah, 4th of July,
Valentine’s, St. Patrick’s Day, Easter
– Themes
• Examples: Super Bowl party, opening day baseball season
BBQ, carnival food, make a meal on appetizers , birthday
party, summer picnic
Types of Meals & Experiences
• Incorporate finger foods and assembling foods
– Wrap bar, taco bar, sandwich bar
• Dessert experiences
– frost cookies, make a gingerbread house, ice cream
sundae bar, chocolate taste test, small box of
chocolates for Valentine’s Day, make dessert for a
peer, identify jelly bean flavors
– Iron Chef dessert competition
Types of Meals & Experiences
• Buffet style, serve self or others serve you
• Share a meal-requires using voice and
negotiations
• Pizza, Chinese, calzones
• Seasonal foods – incorporate fall, summer,
veg/fruits or other traditional foods
• Grocery store – plan, shop, prepare food
Potential Client Challenges
• Social anxiety
– Set goals to address fears (i.e.; sit next to supportive person,
engage in conversation)
• Fear of food or ingredients
– Emphasize need for variety, body knows how to handle new
choices, 1/42 x/wk, ED getting in the way of relationships,
deprivation doesn’t work
– Client may have individual dessert/meal goals
• Fear of not being able to meet meal plan or using
substitution
– Explain flexibility of meal plan when eating away from home
Potential Client Challenges
• Negative self talk
– Use positive affirmations, stay engaged with group
• Emotionally full or hungry
– Stick to meal plan as guide for what body needs
– Use mindfulness exercises around taste, texture,
temperatures and pacing
• Fear of not getting exchanges exactly right
– Remind client goal is not perfection
– Ask for support in figuring out meal plan
– Encourage client to identify source of needing
to be perfect
Potential Client Challenges
• Over use of condiments or fear of using extras
like ketchup, jam, pickles, etc.
– Remind client to normalize food based on typical ways
condiments or extras may be used.
– Reality check fears
• Anger/meltdowns
– Sit next to for support, identify coping skills, partner
for peer support, remove from situation to
de-escalate, identify trigger for fear
Potential Client Challenges
• Refusal to participate
– New admit vs longer term client
• Constant reminder to challenge ED in a safe,
supportive environment and this is why you
are here
Post-meal processing (see handout)
• Hunger/fullness coming out of meal
• Assessment of goals met
• Identify victories and level of control during meal
• ED or recovery focused and why?
• What might you do differently to make it more successful
and/or meaningful next time?
• How did you use your voice during the meal?
Post-meal processing (see handout)
• Memories or associations with the food
• What kinds of feelings, thoughts or self-talk
happened during the meal?
• Any rituals, urges or behaviors?
• What type of feedback and/or support were you
given from peers/dietitian and how did it affect
you?
Meal Experiential Follow-Up Worksheet
Name: ____________________________________
Date: __________________
Fullness on our scale of 1-10: ______
Proteins:
Grains:
Fruit:
Veggie:
Fat:
Total:
# of Exch
_______
_______
_______
_______
_______
_______
Percent of MP completed: ________
Actual Intake
_______
_______
_______
_______
_______
_______
If you had any modification to your MP,
what were they?
Percent of Dessert completed: _______
1.
What victories can you identify from the meal experiential?
2.
How was your influence and association with peers during the meal?
3.
What level of control did you feel during the meal? (1=very controlled; 5=out of control) List examples.
4.
Memories or associations with the food or experience:
5.
Were you more ED or recovery focused during the meal? ED___ Recovery___ List examples of why you believe this:
6.
How did you deal with the struggle you identified on your pre-meal goals sheet that is interfering with recovery?
7.
What would you do differently to make the meal experiential more meaningful for you?
8.
How did you use your voice to express your wants and needs in an assertive manner?
9.
What kind of feelings, thoughts and self-talk were you aware of during the experience?
10. What types of rituals, urges or behaviors did you have during or after the meal?
11. What type of feedback were you given from the dietitian/peers during the meal and how did that affect you?
Summary
• Goal is to push clients toward normal eating
and take the power away from the
food/experience through exposure therapy
• Be creative with meals and make “real world”
scenarios
• Set client up for success with preparation for
experience (pre-meal goals)
• Adequately debrief experience to highlight
victories and improvements needed
(post-meal processing)
Questions & Answers
Feel free to contact Debbie at
Debbie.Richardson@rosewoodranch.com
Reference List
• Satter, E. (1987). How to Get Your Kid to Eat: But Not Too
Much. Kent, England: Bell Publishing Co.
• Eating Disorder Treatment in LA. (2012) Exposure Therapy
in the treatment of Eating Disorders. Author : Lauren
Muhlheim, Psy.D. Retrieved from:
http://eatingdisordertherapyla.com/2012/03/27/exposure-inthe-treatment-of-eating-disorders/
• Leacy, Kim A., Cane, Jessica N. “Effect of Non-Select Menus
on Weight and Eating Concern in Adolescents Hospitalized
With Anorexia Nervosa.” Eating Disorders 20 (2012):
159-167. Print.
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