eating with wisdom: cultivating mindful eating jean l. kristeller, ph.d. center for the study of...
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Eating with Wisdom:Eating with Wisdom:Cultivating Mindful EatingCultivating Mindful Eating
Jean L. Kristeller, Ph.D. Center for the Study of Health, Religion, and Spirituality
The Center for Mindful Eating
www.tcme.org Dept. Of Psychology, Indiana State University
j-kristeller@indstate.edu
Indiana State UniversityIndiana State UniversityBrendan Hallett, Psy.D. and Virgil Sheets, Ph.D.Brendan Hallett, Psy.D. and Virgil Sheets, Ph.D.Juli Buchanan, M.A., Brandy Dean, M.A., and Janis Leigh, B.A.Juli Buchanan, M.A., Brandy Dean, M.A., and Janis Leigh, B.A.
Duke UniversityDuke UniversityRuth Quillian-Wolever, Ph.D.Ruth Quillian-Wolever, Ph.D.
Sasha Loring, M.S.W., Jennifer Davis, M.S., and Jennifer Best, Ph.D. Sasha Loring, M.S.W., Jennifer Davis, M.S., and Jennifer Best, Ph.D.
Richard Surwit, Ph.D. and Richard Liebowitz, M.D.Richard Surwit, Ph.D. and Richard Liebowitz, M.D.
Acknowledgments
MINDFULNESS: a cognitive MINDFULNESS: a cognitive state, marked by attentional state, marked by attentional
stability, that disengages stability, that disengages habitual reactions and habitual reactions and
allows for inner wisdom to allows for inner wisdom to emerge.emerge.
Meditation:Meditation:Mechanisms and MisunderstandingsMechanisms and Misunderstandings
Meditation is NOT primarily a trance state.
Meditation is NOT primarily a relaxation tool.
Meditation is FUNDAMENTALLY a cognitive-attentional process that promotes self-regulation.
It has potential effects across MULTIPLE DOMAINS of psychological functioning: cognitive, physiological, emotional, behavioral, relation to self/others, and spiritual.
Usual Processing: Usual Processing: Conditioning Model & Eating ProblemsConditioning Model & Eating Problems
Usual Thoughts and Experiences
Conditioning ~~ Survival ~~ Attachment/Avoidance
Cognition/Attention
Physiology/Health
Emotions Self/Others
BehaviorSpiritual
XXXX
The Six Domain Model: Eating MindlesslyThe Six Domain Model: Eating Mindlessly
Cognitive: Preoccupation with food/eating; black and white thinking.
Physiological: 1) hyper-reactivity around food. 2) Disconnect from normal hunger and satiation cues.
Emotional: Depression; craving; anxiety.
Behavioral: Binge eating; highly conditioned responses to food; general overeating.
Relationship to Self/Others: Poor self-acceptance; self-hatred; anger at others; over-valuing thinness.
Spiritual: No wise eating; spirituality does not engage honoring body; value and meaning attached to food abundance.
Psychiatric Criteria for Binge Psychiatric Criteria for Binge Eating Disorder (DSM-IV)Eating Disorder (DSM-IV)
1. Recurrent binges, characterized by:
1. Eating, in a discrete period of time, much more than most people would eat.
2. A sense of lack of control during the episode.
2. At least two episodes of binge eating per week for six months.
3. Associated with eating more rapidly, eating until uncomfortably full, eating without being physically hungry &/or feeling very guilty or depressed afterwards.
4. Marked distress regarding binge eating.
3500 KCalories: 3500 KCalories: Overeating vs. BingeingOvereating vs. Bingeing
Overeating PatternOvereating PatternTime KCal7 am 2 eggs, bacon
2 slices toastOJ 450
10 am Doughnut 150
Noon WhopperMedium Fries 1130
6 pm 6 oz. SteakBaked potato2 vegies, rollApple pie 1320
10 pm 2 oz. Doritos1 beer 450
TOTAL 3500
Bingeing PatternBingeing Pattern
KcalCereal/milkOJ 260
Salad/diet dressingRollDiet Coke 300
3 oz steakBaked potato2 vegies 500
2 pieces Apple pie7 oz. Doritos1 pint ice cream 2440
TOTAL3500
MB-EAT:MB-EAT:Mindfulness-Based Eating Awareness TrainingMindfulness-Based Eating Awareness Training
Mindfulness meditation Eating experience meditations:
– Awareness of binge triggers
– Awareness of hunger
– Awareness of satiety (taste-specific, fullness)
Food-related meditations: raisin, chocolate, cheese/crackers, pot luck meal/buffet.
Mini-meditations with daily meals and snacks. Forgiveness and wisdom meditations Homework: meditation practice, mindful eating.
MB-EAT: Outline of SessionsMB-EAT: Outline of Sessions
1) Introduction to mindfulness meditation. Mindfully eating a raisin.
2) Introduction to “mini-meditation”. Mindfully eating cheese and crackers.
3) Binge trigger meditation. Mindfully eating sweet, high fat food.
4) Hunger Signals meditation (physical vs. emotional hunger).
5) Taste-Specific Satiation Signals meditation. Chips and cookies.
6) Stomach Fullness Satiety meditation. Pot luck meal. 7) Forgiveness meditation. 8) Wisdom meditation. 9) Have others noticed?; where do you go from here?
NIH TrialNIH Trial
NCCAM-funded randomized clinical trial with 3 groups: Meditation-based; Psycho-educational; Waiting List.
Two-site design (ISU and Duke).
9 week manualized intervention
1 and 4 month followups
More extensive measures including process measures and change in biological markers of self-regulation (lipid and metabolic profiles)
SampleSample
Sample size: N = 150 evaluated on all baseline measures; 14% men.
Approximately 14% African-American recruitment
Average age = 47.5; Avg. Wt. = 240 lbs.; Avg. BMI = 39.
Changes in Number of Binges in Changes in Number of Binges in Previous MonthPrevious Month
0
2
4
6
8
10
12
14
16
18
Base 1 Month 4 Months
# o
f B
ing
es
Control
PschoEd
MB-EAT
p<.01
(N =85)
Treatment Effects on Treatment Effects on Beck Depression ScaleBeck Depression Scale
0
5
10
15
20
25
Base 1 Month 4 Months
Bec
k D
epre
ssio
n S
cale
Control
PschoEd
MB-EAT
p<.001
(N =85)(N =85)
Treatment Effects on the Three Factor Treatment Effects on the Three Factor Questionnaire: DisinhibitionQuestionnaire: Disinhibition
8
9
10
11
12
13
14
15
Base 1 Month 4 Months
Dis
inh
ibit
ion
Control
PschoEd
MB-EAT
p<.001
MM vs. PE: p <.01
(N =85)(N =85)
Treatment Effects on the Three Factor Treatment Effects on the Three Factor Questionnaire: HungerQuestionnaire: Hunger
4
5
6
7
8
9
10
11
12
Base 1 Month 4 Months
Hu
ng
er Control
PschoEd
MB-EAT
p<.001
MM vs. PE: p <.10
(N =85)(N =85)
Treatment Effects on Treatment Effects on Lowe’s Power of Food ScaleLowe’s Power of Food Scale
40
50
60
70
80
90
100
110
Base 1 Month 4 Months
Po
wer
of
Fo
od
Sca
le
Control
PschoEd
MB-EAT
p<.001;MB vs. PE: p<.10
(N =85)
Treatment Effects Treatment Effects on Weighton Weight
210
220
230
240
250
260
Base 1 Month 4 Months
Wei
gh
t Control
PschoEd
MB-EAT
(N =85)(N =85)
Treatment Effects on Treatment Effects on Post-prandial GlucosePost-prandial Glucose
2.02
2.05
2.08
2.11
2.14
Baseline Post-Tx Follow-up
Po
st-
pra
nd
ial G
luco
se (
log
)
MB-EAT
PsychoEd
Wait-List
Relationship Between Practice Relationship Between Practice
and Improvement in Relation to Eatingand Improvement in Relation to Eating (n = 31-34)(n = 31-34)
Change in:
Type of Practice BESLess
DisinhibitionLess
Hunger Weight
General Mindfulness -.28 -.17 -.26 -.20
Eating Meditation -.26 -.34+ -.20 -.28
Mini-Meditations -.51** -.28 -.19 -.33+
Combined Index -.52** -.38* -.34+ -.41*
Results in Relation to the Multi-Domain ModelResults in Relation to the Multi-Domain Model
Cognitive: Disengagement from food preoccupation.
Physiological: Normalization of hunger and satiation cues; improvement in physiological/metabolic regulation.
Emotional: Decreased depression.
Behavioral: Decreased binging, interruption of highly conditioned responses.
Relationship to Self/Others: Improved self-acceptance; anecdotally, forgiveness of others.
Spiritual: Anecdotally, sense of connecting with the higher, wiser self; using meditation as prayer time.
Current NIH Study: MB-EAT IICurrent NIH Study: MB-EAT II Mindfulness Meditation: Mindfulness Meditation:
Regulating Eating and ObesityRegulating Eating and ObesityPI: Jean L. Kristeller, Ph.D., ISUPI: Jean L. Kristeller, Ph.D., ISU
NCCAM-funded randomized clinical trial with 2 groups: MB-EAT vs. Wait List Control.
Focus on obesity - moderately to morbidly obese (BMI>34).
12 week manualized intervention with increased focus on weight loss, plus 3 month support followup.
6 month total followup.
j-kristeller@indstate.eduj-kristeller@indstate.eduThe Center for Mindful EatingThe Center for Mindful Eating
www.TCME.orgwww.TCME.org
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