Bringing Mindfulness to Fullness

Chinese meal in Suzhou with rice, shrimp, eggp...Image via WikipediaPeople who are struggling with binge-purge problems often find it stressful to make important changes in their binge purge cycle. One of the most difficult aspects of recovery can be tolerating the feelings of fullness that occur after eating. This is not simply a difficulty after a binge, but also after a normal sized meal or snack.

We'd like to get some ideas out to therapists who are taking a mindfulness approach with eating disorders. If you are a person who purges after eating, please talk to your therapist before trying to practice any of these techniques. They may not really be right for you. If you are not seeing a therapist now - what are you waiting for? It's really important to take a purging problem seriously.

One of the strategies we recommend for dealing with uncomfortable fullness is: do something else for half an hour. Take a walk, call a friend, do something absorbing and distracting. Lots of people find that if they can engage in some activity for 30 minutes, the "urge to purge" subsides and the feeling of fullness is less bothersome. It's really important to get through that critical half hour.

In a way, this sounds like an anti-mindfulness approach: try not to pay attention to how you are feeling. In fact, I'd still call it a mindfulness approach, because it is best to engage in the alternate activity with complete mindfulness: while you are walking, really be present in the here and now, be fully aware of your body and your surroundings. It's a matter of bringing our wisdom to bear on the situation. It always good to know what mindfulness practices are too advanced for us. True mindfulness of fullness after a meal can be very hard to actually attain.

We have been working on a "Mindfulness of Fullness" protocol, and wanted to share our ideas with other mindfulness-oriented therapists. We think that the best time to introduce the idea of being mindful of fullness is after the client has already established a basic mindfulness practice, and can pretty reliably use it to calm and center herself. When it seems possible to try it, a mindfulness of fullness meditation can look something like this:

  1. The best situation in which to start the practice is after the client has eaten something that she knows is healthy and nutritious. The feeling of fullness should be noticeable but not overwhelming. It might well be possible to practice this in the office, with the therapist guiding the meditation, during a session that follows lunch or a snack.
  2. Ask the client to rate the sense of fullness she is currently experiencing on a scale from 0 - 10, with 10 being the most full she has ever felt in her life.
  3. Start with a mindful breathing exercise, especially one like our "Mindful Breathing II" (from the right-hand column). It might be good to pay attention to the breath at the nostrils instead of in the belly, just because it's a less conflicted and complicated sensation. If the client is doing this at home, it might be best to actually listen to the mp3 rather than to simply do it from memory. It will support her more in an anxious situation.
  4. Ask the client to get in touch with her reason for doing this meditation: "I want to learn to tolerate my fullness so I can live a longer, healthier life." "I don't want to be afraid of my body any more." "I want to learn to nourish my body." Then, you might try guiding the client through the following steps.
  5. When you're ready, try to notice whatever you can about your present moment experience. If you can, try to notice each element kind of dispassionately. "There's a tightness in the stomach. A thought about purging. A fear of being fat. A desire to learn to eat in a healthy way. "
  6. Try to notice which experiences are just body sensations, which experiences are judgments, which experiences are emotions, and which experiences are thoughts. When you figure it out, you can label the experience: "just thinking" or "just feeling" or "just sensation."
  7. Remember to breathe throughout the exploration, and anytime your anxiety rises.
  8. Try to figure out which aspects of your experience are "optional." Can you let go of making that judgment right now and simply focus on what is basic and real and present? It might be possible to eventually let yourself be aware of your fullness as a simple body experience, without all of the judgment and striving and thought and emotion that you typically add to it. If you can let go of your reactivity to the sensation, and simply be with the sensation as it is, that's a really important milestone.
  9. Rate the sense of fullness you experience on a scale from 0 - 10, with 10 being the most full you have ever felt in your life.
  10. End the meditation with more calming breathing. Again, the "IHP: Mindful Breathing II" exercise is a good one, but the "MARC: 3 minute Metta" could be really helpful, too.
The goal is to be able to tolerate fullness for what it is, a basic and essentially rewarding human experience. Mindfulness can help our clients free themselves from the reactivity and self criticism that turns that experience into something frightening and toxic.

If you are a therapist and have some feedback or ideas about this intervention, please leave a comment. If you'd like more information about our Mindful Eating approach, or about our study group in mindfulness and psychotherapy, feel free to follow these links.

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