Jean Kristeller is professor of psychology and director of the Center for the Study of Health, Religion, and Spirituality at Indiana State University. For over twenty-five years she has conducted research into the psychology of meditation, including investigations on the effects of meditation on heart-rate control, general well-being, spirituality, psoriasis and anxiety disorders. She is currently investigating the value of Mindfulness-Based Eating Awareness Training (MB-EAT) on compulsive overeating and obesity and is a founding member and president of the Center for Mindful Eating (www.tcme.org), a virtual organization bringing resources about mindful eating to professionals in related fields. Inquiring Mind editors Barbara Gates and Kevin Griffin interviewed Dr. Kristeller by phone in November 2009.
Inquiring Mind: When did you begin to see that the practices of Buddhism might be useful in working with people around food-related suffering?
Jean Kristeller: When I was at the University of Massachusetts, I had the opportunity to sit in on the Mindfulness-Based Stress Reduction program, and it was that first experience of eating a raisin mindfully that blew open the door. I had already been using meditation practice as part of a treatment program I’d developed for obesity and compulsive overeating, but from within a stress-management framework. I saw that mindfulness training not only offered tools for relaxation and managing stress-related eating but also for totally shifting one’s relationship to food. That was really the beginning of the MB-EAT program. I began to explore ways to bring mindfulness practice to eating, beginning with the raisin but expanding into more challenging types of food—addressing the complexities of our relationship to food, to eating and to our bodies.
IM: How are eating disorders and addiction to eating similar and different from other addictions?
JK: First, it’s important to clarify that MB-EAT is not based on an addiction model. I don’t think an understanding of food as an addiction leads people down the most helpful path. Such an approach is predicated on the idea of abstinence. People will say, “While you do have to eat, you can abstain from certain foods.” But I see a built-in trap to this approach: one slip and you’re “off the wagon” and at risk to just keep on eating. Many people who get into a dieting mind-set are already vulnerable to this. I had some struggles with this approach personally, and in my case, I found it utterly unhelpful.
Although an imbalanced relationship with food can include some parallels with the addictive process—such as the craving and the sense that a substance has a hold on you—the perspective that particular foods act for certain people as alcohol or drugs do for others isn’t well documented. If that were the case, the people we work with would be coming back to us and saying, “I can’t have a small piece of cookie and enjoy it without eating the whole box.” In fact, they very quickly come back to us and say, “When I bring the quality of mindfulness to eating—when I fully appreciate the experience, the flavors, the taste—then I find that I am satisfied with a small amount.” Some people even say, “I thought these were my favorite cookies, but eating them mindfully I find I really don’t like them because they’re not very satisfying.” That’s a very different result from what you would predict through an addiction model.
So I’m much more interested in creating a relationship with eating that is not about a struggle but about finding a balance with food and eating in the context of open acceptance. We use mindfulness meditation to help people cultivate “inner wisdom.”
IM: Why do you think it is so important to be able to eat anything? Why not abstain from certain foods if that’s workable for you?
JK: If it’s truly workable, that would be one point of choice. But another choice involves progressively shifting your relationship to increasingly challenging foods. In our program, we start with mindfully eating a raisin, and we end up bringing the tool of mindfulness to an all-you-can-eat buffet. We certainly couldn’t assign attending such a buffet early in our program, but we find that virtually everyone discovers that they can handle it once they have the foundation of practice and experience. Yes, perhaps they will overeat a bit—because virtually all people overeat in that kind of setting—but they will be able to say, “Just because I overate, I’m not a bad person. Maybe I won’t go to these places too often anymore, but when I do go, I am going to be able to relate in a far different way from how I did in the past.”
IM: Is it your sense that people change their relationship to food enough through your programs that they no longer tend to use food to try to cope with stressful situations?
JK: It’s an ongoing process. Many people use eating to help handle stressful situations. In research we did at Yale, we found that even “balanced” eaters reported using food to help with stress. But people who didn’t have eating problems used the food, in reasonable amounts, to comfort themselves, whereas those with more conflict about their eating would get distressed about doing so and then overeat even more. For example, while in day-to-day life some people can easily dip into a bag of pretzels and enjoy a few, on a vacation with family they may get stressed and eat the whole bag.
Food is something that comforts us inherently. So in our program we talk both about finding alternatives to eating when under stress and also about finding your comfort foods and learning how to use those favorite foods in a way that makes sense for you rather than eating them out of control—how to have a few pretzels or a bowl of ice cream without eating the entire bag or carton.
IM: How does your program deal with the downward spiral: eating one bowl of ice cream, then the feeling guilt and self-hatred that leads to two quarts?
JK: You’re right. It’s the self-hatred that’s more of the problem. We draw on a concept that was introduced into the therapy literature by Alan Marlatt, the “abstinence violation effect”: “I wasn’t going to have any ice cream, but I had some. Therefore I am a weak-willed person, and since I blew it, I might as well just keep on going.” We help a person see that the decision to have ice cream does not mean that he or she is by nature weak-willed. There’s also a lot of relief in recognizing, Oh, everybody in this room has similar feelings. People begin to find a tremendous release in saying, “I don’t have to beat myself up for eating a given food.”
In working with people with binge eating disorders who are experiencing a spiral of self-hatred and self-punishment, we encourage them to be aware of how their thoughts drive this chain of reactions. We do some lovingkindness meditation. We use the body scan and add something we call “healing self-touch.” People gently move their hands over their bodies in a very accepting way. They rest their hands on parts of their bodies where they may have a lot of ambivalent or negative feelings and let the experience of appreciation for the body come from their hands into their legs or their stomachs. We also use a forgiveness meditation that is very powerful. We frame it primarily around forgiving oneself for having gotten out of control around eating.
IM: I bet there are a lot of tears when you are doing that.
JK: Yes, there are. But primarily we work with people on their relationship with food. After the raisin we move to increasingly challenging foods, the foods people tend to binge on, like cheese and crackers. When people say, “I’m not supposed to eat those,” we say, “Let’s look at how many calories are actually in this; it’s trivial, maybe twenty calories.” People always overestimate the number of calories in the little bits of food we offer them.
Next we move on to brownies. People say, “Oh, my god! You’re giving us brownies? This is a program that’s supposed to help us get our weight under control.” We reply, “But people don’t binge on carrot sticks. We want you to shift your relationship to brownies.” When the brownies first come into the room, people think they want to eat the entire plate. But their actual experience—once they’ve eaten a piece of a brownie in the same mindful way they ate the raisin—is that they really enjoy the first few bites and after that don’t really taste it anymore. The next week they come in and share how amazing this was, that they’d suddenly realized brownies didn’t have the same kind of hold on them as they had just a week earlier.
IM: It’s amazing that a lot of people wouldn’t have gone out and bought a whole box of brownies after having had a bite.
JK: Well, not really, or we wouldn’t be doing it. In another very important exercise, we work with making mindful choices using two different snack foods. We give people a choice between sugar cookies and corn chips. Then we ask them to look at why they made their choice—what it is in their inner experience that drew them to one or the other. We next ask them to eat a little bit, then a little bit more, and to really savor it. This ties back into another fundamental process in food intake regulation, called “sensory-specific satiety.” We refer to it as “taste satisfaction.” Physiologically, our taste buds habituate to flavors after a few bites. Research has shown that people with eating problems tend to be much less sensitive to this. So we ask people to eat slowly, fully savoring what they are eating but stopping when the food doesn’t taste as good anymore. We ask them to notice when their inner-enjoyment meter has gone up as high as it is going to go and when it starts to come back down again. Typically this might take only a couple of cookies or four or five corn chips. People are often amazed that “I didn’t stop because I thought I should, but because I realized I didn’t want any more.”
IM: So you’re saying that binging doesn’t seem to be caused by a particular food or the circumstances but rather by being unconscious. Instead of dealing with a food per se, MB-EAT deals with the consciousness, bringing the experience into mindful awareness.
JK: This is complicated. Sometimes overeating does feel like it’s about the food itself—ice cream or pizza or chocolate. Certainly those foods have specific physical effects on the body and on the brain. In the drug and alcohol area, to some substantive degree the sense of craving and compulsion is about the particular drug. But with food, overeating is really about the relationship that has been created and developed around a food. We see people dramatically shift in their experience of the very foods that had previously represented binge foods to them. As people continue through the program, we work with being aware of physical hunger in contrast to other triggers for the desire to eat. And we make it very clear that those triggers are not, for the most part, in and of themselves pathological.
We also help people tune in to stomach fullness. Many overeaters are only aware of being empty—and then being totally full. We introduce a ten-point scale for fullness, with one being not full at all and ten being as full as possible. This allows people to begin to notice that often they eat to a nine or a ten. We find that most people can easily reacquaint themselves with what middle levels of fullness feel like. Fine-tuning the distinctions between levels of fullness can actually happen surprisingly quickly. For example, someone who had previously binge eaten multiple times per week reported, “This week was really great, but I had one day that was difficult because I meant to eat only to a five or six but ate to an eight.”
We then work with another choice: instead of being “mindless” and automatic, participants evaluate what food to eat in what amounts. One woman described going to the all-you-can-eat buffet before she started the program. She would start out intending to eat in a very healthy way, selecting salads, green beans and chicken (removing all the skin), but she wouldn’t be satisfied. So she would go back through the buffet, choosing another entire meal of the foods she had really wanted in the first place. Now, when she chooses among foods in a more mindful way, she picks smaller amounts of foods that are actually appealing to her and ends up eating far less and feeling much more satisfied.
We also do a lot of work with what we call “outer wisdom,” based on the idea that we have a lot of knowledge around food—such as calorie levels and nutritional value—that we can employ as useful information instead of using it to beat ourselves up or set impossible goals, like “I’m only going to eat 1,000 calories a day.” We can use our knowledge to find a balanced relationship with food: “Instead of three bowls of diet ice cream, I’ll eat half a bowl of my favorite rich ice cream slowly and mindfully, which will be fewer calories and totally satisfying.”
IM: What about meditation?
JK: We emphasize the importance of establishing a sitting meditation practice for cultivating increased mindfulness, and we also explicitly encourage people to take mindfulness practice into their day-to-day activities, starting with their eating. We have a practice we call “mini-meditation.” For instance, we suggest that people stop, center themselves, and bring awareness to their thoughts, feelings and experiences around an eating or food situation, such as sitting in front of a piece of chocolate cake or pizza. Pause and bring your awareness to your hunger (and the degree to which it’s about physical hunger or some other need for eating), to your anticipation of eating that food, to making a decision about how to relate to that food (whether to eat it or how much to eat), and once you start eating, to the experience of eating. Such a mini-meditation is the tool that people say is the most useful and the most powerful—and our research data supports that.
Finally, I want to emphasize that mindful eating is not about always eating slowly. People will say, “I can’t possibly eat all my meals like I ate that raisin.” Our reply is, “We’re helping you learn to bring these tools into any experience of eating.” That may mean making a more mindful choice about what to eat for lunch, even if they have to gobble it down because they’ve got a meeting in five minutes. That’s very different from just grabbing something and automatically eating it.
IM: Gobbling but being aware that you’re gobbling.
JK: In the moment, being aware that you’re gobbling and accepting that, unfortunately, gobbling was all you had time for that day!