Session four: bumps in the road

This week has been hard for me. I found myself over the weekend beginning to feel depressed and anxious in a way that I had not in a long time. By Monday I spent the evening in tears and Tuesday I was a disaster. Try as I might, I could not quite put my finger on the cause of the sudden low mood and sadness I was experiencing and I was feeling desperate by my Thursday therapy session.

The Greenlight program is structured for sure, so I was not sure how my therapist would react to my needing more emotional support than education. She was great. I explained that I was feeling depressed, having a lot of difficulty seeing things clearly, and that I felt out of control.

Here was her perspective (which helped me immediately):
People who are "thinkers" have a tendency to think their mood down. I had this general idea of when my mood took a turn for the worse - it was after a conversation that left me feeling insecure - but because my depression seemed more severe than would result form that conversation, I sort of disregarded it as the possible source. Instead, I kept subconsciously thinking through all of these sad things trying to figure out which of them was the cause of my sadness. As a result, I became more upset.

My therapist asked me to picture my mood as the elevator in a building that is ten stories. If you are on the top five floors you are more likely to have the ability to think clearly. If you have sunk below floor five you have lost some of that ability. Her suggestion: when you get to those lower levels get up and do something that will make you feel physically better. Take a walk. Listen to good music. Call a friend. Do something nice for someone. Get a cup of coffee. The physical act lifts your mood enough to allow you some perspective.

I also realized through this exercise that I have used food as the physical thing I do to make myself feel better for years. Not having that crutch anymore made me more vulnerable and I did not know how to operate in that environment.

There was a whole other part of this session about super glue words that I will write about soon, but this part was important enough that it deserved it's own post.

Shoulds and Wants and childrearing

I had a short session with my therapist today in which we talked about 'shoulds' vs. 'wants' in a way that was both interesting and overwhelming.

Here is my illustration of what she described.

What it means is that during childhood we are our authentic selves. We are not yet subject to society's (or family's) pressures or expectations. We do what we want, we say what we want. Sometime around age 10-12 (at least for girls) there is a split at which people are told that what they want is not what they should have and that what they should have is not what they want. Kids start to do what they "should," when they would be much happier listening to their authentic selves. The 'wants' and the 'shoulds' belong together.

Research shows that there are five things that people think girls "should" be: popular, pretty, thin, "nice," and smart. Girls either try to meet these expectations, or they buck them and are instead: counter-cultural, they partake in whatever is the opposite of that society deems "pretty" (i.e., they get tattoos or piercings); pay no attention to their physical health, are blunt, and street smart.

Most of out core beliefs as women are based on one of those five things. You don't say what you want to so that you are not thought rude. You don't do what you want to because of how you think it will look.

In actuality, we probably don't want to be popular, we want to be well-respected or well thought of. Being popular is exhausting. We don't want to be pretty, we want to feel attractive. We don't want to be thin as much as we want to be strong and healthy.

I have been thinking a lot about this as it relates to raising my baby girls. Encouraging them to listen to themselves will be more of a priority for me than it has been. Hopefully I will remember this when they are reaching that critical pre-teen stage.

The Christmas party

This weekend was the last of our holiday parties. I was nervous about what I was going to eat because most things people were bringing were mayonnaise-laden and delicious. And because we tend to hang out for 8 or 9 hours, there are often several round of eating.

I got some advice from my therapist that was really helpful:

First, she suggested that I look at the eating as courses. I brought a big salad (which I really wanted) and ate a plate of it first. An hour or so later I went for a "dinner" plate and made sure my plate looked balanced. Not having a little bit of everything, but instead picking the carbohydrate I wanted the most, the protein I wanted the most, and then fruit. It allowed me to integrate with everyone else without feeling out of control. When people went back for dessert I ate a snack that I had brought with me. It was pretty successful!

I also sat down while I ate. That helped me be more mindful about what I was doing.

All of that anxiety for nothing!

Starting to think about thinking

This week begins the part of the program that I am looking forward to most: starting to look at the way I think about food and how to manage those thoughts. Awareness.

We started by talking about automatic thoughts. The thoughts that you have automatically, and that are based in part on past experience, and that lead to feelings (or potentially physical sensations) and eventually to actions. The idea that we have the ability to pause that process - that is, to have a thought, feel a feeling and then take a beat before acting, is both obvious and sort of life-altering. In my life I rarely stop to consider the consequences of my food-related actions that way that I do other actions. It has become automated. Learning to manage that process differently could really make a huge difference. 

So, as a check on my automatic thoughts, I will check them against two criteria: Is the thought true? Is what I'm thinking helpful? As someone who has had cognitive behavioral therapy in the past, this is not a new concept to me, but it is an important one. I needed the reminder that I make all sorts of assumptions about things that influence my decision making. It was also a good reminder that I suffer all sort of cognitive distortions. Especially when it comes to food and dieting.

I also realize that I bypass listening to my internal dialogue when it comes to food. It is not as if I dismiss it (which I suppose I used to), at this point I think I just ignore that it is happening. My counselor explained that the brain essentially "powers down" when a person is engaging in habits. There is research that says that when we see certain cues (like a bag of potato chips) we act automatically (by eating it) and can often come out on the other side without really remembering the act of eating all the chips.

Cognitive distortions are really just a string of negative thoughts that lead to negative feelings/behaviors. If you think something often enough you begin to believe it. There are a few cognitive distortions that I am particularly prone to:

All or nothing thinking: This is black and white thinking. If you are not perfect you have failed. I have been saying this about nearly every aspect of my life for as long as I can remember. I just do not do well with moderation. I am either being careful about that I eat or I am eating a McChicken on my way home from dinner (and if I eat that McChicken I am likely to think I have blown the day anyway and just eat whatever I want.
The correction: Think in gray.

Overgeneralization: Seeing one negative event into a pattern - "I always get in the longest line." Do you really? Or do you just notice it when you are in the long line. The experience is not the rule.

Disqualifying the positive: I do this all the time. I will lose a bit of weight and feel good about it for a minute, but almost always immediately think about how much more there is to go. I do this with compliments, too. I am always quick to downplay whatever it is someone comments on, which is really doing them a disservice. If you don't accept the compliment you sort of require them to give a second compliment.

Jumping to conclusions - Mind reading: Assuming that people are thinking something in particular. There is no way to know what anyone else is thinking. Even those you know well. Let it go. You can't possibly know.

Catastrophizing: Striking out in your mind before you even get to bat. Jumping to the conclusion that even if things did go wrong, it would be a catastrophe.

Should statements: Using should statements to motivate yourself. The result is guilt. "Should" reflects someone else's expectation.
The correction: I wish I had/hadn't - reflects your wants

The goal: try to be more objective in your thinking. Get outside of the negative thought process.

Also interesting in this session was the idea that people who are not depressed tend to have a 1:1 ratio of negative to positive thoughts, where people who are depressed or anxious might have a 2:1 ratio. (I would have guessed that was like 20:1) Paying attention to automatic thoughts can really help.

Summary of week two: met goals, felt good, felt satisfied

Total weight loss: 8 lbs

Going shopping

I was equal parts looking forward to and dreading week two - grocery shopping. During this session the therapist and I toured the local Schnucks to look at the tons of products that fit a low-fat model of eating, and to talk about some pitfalls (read: peanut butter!). The dread came only from the idea of onlookers and passersby. Ridiculous really - I am not the sort of person to care much what others think - but I felt particularly self conscious.

It was a really helpful exercise and I learned a bunch of things that I was able to implement immediately. That said, as I was walking to my car this 60-something year old woman stopped me to say that she overheard much of the conversation I had been having in the store and she was glad I was taking positive steps to improve my life. I mean, I know she was not being malicious, but really? I said something unintelligible but kind sounding and rushed off to my car. What I wanted to say was "do you need help loading that carton of cigarettes into your trunk?

Here is a somewhat crude listing of the tips I picked up on this trip:

• Boars Head lunch meats – lower fat – including roast beef, turkey and ham. Great way to add protein to breakfast.
• Wedge cheese – many flavors. Laughing Cow and Sonoma Jack.
• Hummus – traditional vs. black bean hummus – Black bean is much better (1.5g v 5g!)!
• Salsa is much better than guacamole as a dip, but guacamole is a great spread.
• Pretzel thins - great harm reduction food (10g of fat in the entire bag – still 700 calories) – Bang for the buck!
• Laughing cow – french onion, queso, blue cheese, etc .
• (2 servings of pretzels and 2 wedges of cheese – 6g of fat 300 calorie snack)
• Fat free Feta, low-fat feta. Baybel
• USE A FINE GRATER TO GRATE CHEESE
• Buy the smallest fruit available. 90 calories is regular banana, 130 in larger
• Use fillers – peppers, zucchini, tomatoes, etc.
• COLORS MATTER. Each of them has their own antioxidants and biochemical. Eat across the color spectrum
• Veggie turkey, boca burgers, etc.
• Seafood – white fish or salmon. Start with Tilapia.
• PB2 peanut butter – try it? – dehydrated and added butter. 1tbls is 1.5 g of fat; very low calories – also make it in chocolate.
• Bagels – mini bagels are the size regular bagels in the past. The minis come in pretzel, too!
• Bread – Sara Lee 45 calorie, though the bread we buy is fine. Avg. bread is 100 calories per slice.
• Hormel 98% fat free chili (over a baked potato)
• Tuna creations (little bit of a light mayo)
• Dressings: Kraft light dressings & Hendricks
• Prepared frozen? Fish
• Side –make without oil and butter. Tastes just as good
• Use lots of spice packets – gillers, crockpots, etc. Use the oil as directed, tenderizes the meat
• Tacos – anything is fine in moderation. Tortillas – buy the smaller!
• Chef Boyardee – 98% fat free
• Boboli pizza crusts – pepperoni – turkey! Not refrigerated.
• Soups, clearer the better.
• Lunch = 10-15g of fat
• Beans – will not bother you if you rinse them first. Black beans, kidney beans.
• Kansas city steak seasoning
• Low-fat baking: 2 egg whites = one egg (there is 5 grams of fat in each egg yolk, so you really get a savings); use applesauce instead of oil; with chocolate and spice cake – use one can of Libby’s pumpkin and a half of cup of water and back as directed. Make cupcakes, freeze them, warm in the microwave.
• Cereal – need fiber, sugar not the first ingredient, Try Fiber One raisan; Special K; more than 20 carbs is bad. Great grains – even if there is a lot of fat there is a trade-off because of the great nutrition
• Bars: oats & chocolate; Oats and peanut butter. You won’t really overeat them. If you do over do it, switch Fiber-one bar and then an apple, over and over. Chocolate brownie Fiber one and a piece of fruit is a great snack.
• Syrup – light, but compare.
• Buy 100 calorie pack, pringles experiment
• Buy smart mix of small chip bags for kids. Baked Cheetos, etc.
• Crackers – Special K wheat crackers. Laughing cow cheese and that is a great snack
• Use a Luna bar to determine if a bar is a candy bar or a protein bar. Start with Luna bars!
• Buy candy at the register. Eat it and be done with it. Peppermint patties, three musketeer bars, better options.
• Popcorn – 100 calorie pack. Better off buying smart pop, adding butter at home. Parmesan cheese.
• Nuts – non-salted, small packs.
• Ice cream – single serving slow churned, or slow churned; skinny cow ice cream bars – chocolate drizzle;
• WATCH FOR THINGS THAT SAY NO TRANS FAT - they are hiding something.
• Frozen fruit
• The redder the meat the lower the fat – get LOINS, stay away from chucks – loins and rounds: a lot less fat
• Breakfast sandwiches – Jimmy Dean Delights. 
• Spicy black bean burgers – morning star
• Frozen french fries are not as bad as you think.
• Lean Cuisine – paninis; bbq chicken pizza; marghetrita pizza
• Lloyds – on pizza? With smashed black beans; people rave about all of them.
• Dairy – yogurt, they make smaller sizes than the ones I wanted.
• Ultra thin cheese slices – one slice is okay, such low fat; 2% cheese is a great option
• Fat free cheese does not melt well, but low fat does. Fat free is great in salads.
• Pudding snack pack
• Sleep better it you have a little carbohydrate before better
• Butter – smart balance light.
• Spray butter is great for baked potatoes.
• Egg whites, egg beaters.

If I forget, someone remind me to tell you the 3 stories: the one about poison ivy, the one about arm-wrestling, and the one about Pringles.

Summary of the first week: met goals, felt good, felt satisfied

Weight loss: 4 lbs

Lifestyle vs. Diet

Heading into my first coaching session I was feeling good! I had successfully logged my meals in the intervening days and I was having no trouble staying well below the 65-grams-of-fat-per-day goal.

Coaching is short, about 30 minutes, and I have chosen to do mine at 8am on Mondays. Because I have evidently never met myself at 8am on a Monday morning. Ha. 

The primary take-away from this session was an important one. There is a huge difference between making a lifestyle change and starting a diet. There is diet language: fail/succeed, deprivation, calorie restriction, etc., that have no place in this program. Where you are either "on" or "off" a diet (and when you are off you are really off), Greenlight is designed to help you make changes that are permanent and comfortable. It is not someone else's plan - it is a plan you deign for yourself based on the information you learn. Instead of a light switch it is a dimmer switch. You can't fail. 

I will have to watch to be sure I don't use those dieting terms in my internal dialogue...

We also talked about the reasons for logging. There are 5 main reasons:

1. Fluency - you have to understand what you are talking about. Literally. And fluency leads to flexibility.
2. Accountability - you have to understand the impact of your choices on your goals.
3. Mindfullness - you have to be aware of what you are eating.
4. Consequential thinking - you can think through the choices and find the best deal - the best bang for the calorie/fat-buck.
5. De-catastrophization - a bad decision (or a bad day) is just that - it doesn't mean anything more than that. It certainly doesn't mean that you should scrap your good decision making until you choose to start over. There is no start or end to this program. 

The final take-away was a big one for me: try to judge an activity by how you feel when it is over. No one who is dreading exercise finds motivation while sitting on the couch. Put on your shoes, it gets you one step closer. Motivation builds. Look for progress, not perfection. 

Beginning with Biology

I was both eager and anxious to have my first Greenlight session. I felt motivated and intimidated, empowered and  powerless, and any number of other paradoxical emotions.

Each session begins with a simple weigh-in followed by the question "does that make sense to you." In this case I had maintained the weight I recorded at my assessment about a month prior, which I suppose made sense given that I had changed none of my behaviors and that I had been especially generous in my food choices leading up to my first session - after all, what if it was my last chance to have the foods I love the most?

We then moved into a conference room with a oft-used white board and a conference table and chairs. It was comfortable while at the same time reinforcing the idea that this process was going to be different than your typical sit-in-the-overstuffed-chair-and-talk model of counseling (a model I also love) - this was going to be about classroom-style teaching and learning. 

But if Cherie (the counselor) was serving as the teacher, she was the sort of teacher with whom you would stay in contact long after classes end. She made clear from the beginning that where I felt weakness she saw strength, and that she respected me as a person who has been fighting a battle (albeit without the best weapons). 

We started by looking at positive and negative aspects of weight-loss. At the outset I thought, "negative aspects, I doubt it," but as I was forced to consider the possibility, I realized that there are some downsides: Not being able to eat whatever I want! The expense of healthier food choices. The challenge of learning to think through food choices differently. No longer partaking in the delicious high-fat appetizers at happy hours. 

None of those was enough to dissuade me, but they did give me a more realistic outlook. 

Then we launched into biology. Here is what I learned:

• Everyone has a different number of fat cells. Those with more fat cells "hear" their hunger signals much "louder" than those with fewer. They are hungrier. Those born to parents who are overweight are born with more, and fat cells cannot go away. 
• Genetics make a difference, but environment can make a huge difference. 
• There are a variety of body types. Mine, type 'C', is particularly efficient at storing fat (which would have been fantastic if I lived at a time when I had to hunt my own food...). For instance, if I ate a 100 grams of fat my body might store 92 of those grams. Another person's body might store 10% fewer, which over time really adds up. 
• There are three things that successful weight controllers consistently do (this is based on research from the National Weight Control Registry):
• Eat a low-fat diet (30% or less of total calories are from fat)
• They log. They keep track of calories, or fat, or some aspect of their eating
• They exercise 
• If you are overweight (or at least if you are a type 'C' body), the balance between eating and exercise should be around 80/20. If you have greater capacity and overeat there are too many calories to burn off with reasonable amounts of exercise. 

Perhaps the most impactful part of the first session came from the discussion of the harm reduction principle that is the foundation of the Greenlight program. There are three components.

1. Perfection is the enemy of good. Learn to be good at good enough.
2.  One size doesn't fit all. 
3. Something is better than nothing. 

I felt as if those were written for me - not even just as it relates to food, as it relates to everything. The idea is to mitigate the harm. I will be thinking about that as I go to sleep.

Finally we talked about logging, which for this program means writing down what I eat and much fat it contains. No need to count calories or carbs (though it is important to be conscious of the calories). Oh, and I should note there are four loopholes to the low-fat foods-are-fine mantra: cereal, bread, sugary candy, and beverages. Those things are all low-fat, but the calories in them can add up quickly. 

So, I left my first session with homework: think about the positive and negative aspects of weight loss and start logging; and with two SMART goals: log 4 days (pencil and paper), and stay within my fat-gram goals on 2 of those 4 days. Seems pretty simple. So far so good. 

Getting Started and Coming to Terms With Terms

After a delay of more than a month, I have finally started the Greenlight Program. I have lots to say about the first session, but it dawns on me that I did not talk at all about the assessment session I had a few weeks ago.

At my initial consultation I was given a variety of patient information sheets to complete and bring back at my assessment appointment. Most of the forms were standard: personal medical history, family medical history, etc., but there was also an extensive section that dealt with personal relationships that forced me to think about the people I choose to include in my life and to evaluate them in terms of closeness and the positive/negative effect they had in my life. I really enjoyed being forced to objectively evaluate an otherwise emotionally driven set of choices. 

The assessment lasted a couple of hours and was pretty painless. There were some measurements taken, weight, blood pressure, etc., and then we sat down and went through my paperwork, pausing to discuss things that were unclear or particularly relevant, and then arriving at a diagnosis: Generalized Anxiety Disorder, Depression, and Eating Disorder, NOS with Binge-eating. 

The anxiety/depression disorders were not at all surprising - I had Web-MD diagnosed myself with those things a thousand times. The eating disorder was a harder pill to swallow. It sort of felt like a sucker punch. I mean, I have a lot of weight to lose so I obviously have disordered eating, but "eating disorder" always seemed to me like something that was dealt with by the star of an ABC Afterschool Special. I learned a lot about anorexia and bulimia growing up - someone suffered with one or the other of those things in every teenage drama - but no one talked about the disordered eating that happens at the other end of the spectrum. In some ways having a label makes me feel more in control - identify and define a problem and you can find a solution. In other ways it feels somewhat oppressive. 

I am going to work on coming to terms with the terms.  

More on week one shortly - it is exciting stuff.