Issue 124 mindfulness and nutrition

SKILLS AND LEARNING

Nikki Brierley Specialist Dietitian and CBT Therapist

Nikki has been a HCPC Registered Dietitian for eight years and more recently gained BABCP accreditation as a CBT Therapist.

She currently works in a dual role within the Adult Community Eating Disorder Service at Cheshire and Wirral Partnership NHS Foundation Trust.

For full article references please email info@ networkhealth group.co.uk

MINDFULNESS AND NUTRITION Mindfulness is now a commonly used term and is a widely accepted method of dealing with the stresses and challenges of daily life. It also has the potential to reduce ‘mindless eating’ and positively affect eating behaviours and nutritional status.

Mindfulness is a simple process; nevertheless, it can be difficult to define and there are many differing opinions about how it is best achieved and what purpose it serves. It is, however, accepted that mindfulness involves deliberately focusing attention on the present experience, in a non-judgemental manner and that this results in a state where there is an increased awareness of the emotional, mental and physical sensations being experienced in the moment.1 Figure 1 provides a simple overview of mindfulness in the form of a diagram.

With a rich history, mindfulness appears to have originated and developed in Hindu and Buddhist traditions. However, following a specific religion is not a requirement of practicing

Figure 1: What is mindfulness?

Source: www.getselfhelp.co.uk/mindfulness.htm

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mindfulness and the process does not conflict with faith or scientific beliefs. The popularity of mindfulness in Western society, greatly increased after Jon KabatZinn recognised and researched the potential benefits in the clinical setting.

There is now a large body of evidence that demonstrates the effectiveness of mindfulness in reducing psychological distress across a variety of conditions.1 THE POTENTIAL BENEFITS

The benefits of mindfulness are generally described as ‘conscious living’, in that the practice of mindfulness can allow individuals to detach from their thoughts and connect with the observing self (i.e. the part that is aware of, but separate from the thinking self). Learning and

Figure 2: Mindless eating

Thought I have so much to do, how am I going to get it done?

Physical Sensation Knot in stomach and tense

Emotion Apprehension and fear

Behaviour Automatic response = Eat comforting food

applying these skills can help individuals to live in a manner that is consistent with their personal values and to develop psychological flexibility.1 Mindfulness most certainly isn’t the answer to everything, although it is increasingly used within psychological services as part of therapy for a variety of different mental health concerns. In addition, there is strong evidence for the value of regular practice on overall health and wellbeing.2 As mindfulness helps with recognising emotions and the negative methods that are used to control and suppress feelings/urges, it

is easy to see the possible benefit of applying this approach to nutritional intake in order to reduce ‘mindless’ eating. Mindless eating can be described as eating on automatic pilot, with little or no conscious awareness of choice. Figures 2 and 3 demonstrate an example of the potential differences between mindless and mindful eating. The cultivation of moment-to-moment awareness can help to create a calmer and more assertive approach to eating behaviours and thus may provide the space to recognise unhelpful and self-limiting patterns.

Figure 3: Mindful eating

Thought I am having the thought "I have so much to do, how am I going to get it done?"

Emotion I am aware I am feeling apprehension and fear

Physical Sensation I am experiencing a knot in stomach and feel tense

Behaviour Practice mindfulness = Acknowledge thoughts and feelings, choose not to eat at this moment

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SKILLS AND LEARNING Table 1: Eating mindfully Slow down the pace.

Eat without distractions.

Become aware of hunger and fullness signals and use them to guide decisions.

Acknowledge and observe the response to food in a non-judgemental manner.

Choose foods that are both enjoyable and nutritional.

Reflect on experience of mindless eating.

Introduce mindfulness as part of daily activities.

Source: Adapted from Susan Albers (2009)4

MINDFULNESS TECHNIQUES

The best way to understand mindfulness is to practice and experience it on a regular basis.

There is a wealth of training providers available, with resources in the form of books, CDs, weekly classes, workshops and retreats.

It is important to remember that the fundamental factor is to deliberately focus on the present experience, in a non-judgemental manner. The aim is not to ‘empty the mind’ or ‘ignore thoughts’, instead it is to become aware of the here and now and to simply observe anything that arises during the practice. There are various methods to introduce the practice and different options suit different people.

There are also specific mindful eating exercises that involve focusing on the consumption of food items in a slow and deliberate manner.

Commonly used items include chocolate and raisins, however any suitable small food can be chosen. The aim of the exercises is to learn to engage with the food that is being eaten, to notice the appearance of the food, the textures and smells and to recognise how the body and mind react to the eating process.

Some of the most common exercises are briefly described opposite and these are often referred to as formal practice.

INTEGRATING MINDFULNESS

The exercises described in this article can be extremely useful and an excellent introduction to mindfulness. It is, however, also recommended

that mindfulness is incorporated into everyday daily activities (i.e. making/drinking a cup of tea, brushing teeth, walking etc), and that generally, on a day-to-day/moment-to-moment basis, there is an increased awareness of thoughts, feeling, sensations and surroundings. With regards to eating, again completing a mindful eating exercise can be an ideal starting point.

It is, nevertheless, acknowledged that eating a small quantity of food in such a slow and deliberate manner may not be possible or desirable in everyday circumstances. Instead, it is suggested that general mindfulness approach is adapted as described in Table 1.

SUMMARY

Mindfulness involves deliberately focusing on the present, in a non-judgemental manner, the results of which include increased awareness of the emotional, mental and physical sensations that are being experienced in the moment. This can develop a connection to the observing self and thus give rise to ‘conscious living’.

As such, in its very nature, mindfulness has the potential to help individuals make nutritional decisions that are not based on emotional or habitual patterns (i.e. mindless eating). By teaching the skills of bringing awareness to the present moment, in a non-judgemental manner, the chances of eating in line with values and goals may be greatly increased. Therefore, mindfulness may be an important approach to include when recommending nutritional changes.

References 1 Jon Kabat-Zinn (2014). Wherever you go there you are - Mindfulness meditations for everyday life 2 www.nhs.uk/conditions/stress-anxiety-depression/pages/mindfulness.aspx 3 Breath Works Mindfulness for Stress, A Four Session Course. www.breathworks-mindfulness.org.uk/ 4 Susan Albers (2009) Eat, drink and be mindful

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MINDFULNESS EXERCISES 1 Breath meditation/breathing exercise This can be practiced sitting, standing or lying down and can be done for 1+ minutes: •

Begin by noticing the breath, being aware of the breathing in and out.

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Without trying to change the breath, notice what is happening in the body and feel the breath (i.e. slowly move focus of what happens in the rib cage, the stomach, the abdomen, the lower, middle and upper back, the shoulders, the nose, the lips and the throat).

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Notice the rhythm of the breath and how it changes.

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As thoughts arise, notice any thoughts and then bring the awareness back to the breath.

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Finish the practice and bring the awareness back to the surroundings.

2 Body scan This is commonly practiced lying down and lasts between 10-20 minutes: • Begin by bringing the awareness to the belly and how it rises and falls with the breath.

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Move the awareness to solar plexus and then to the chest.

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Take the awareness to the lower back, be aware of the subtle movement with the breath.

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Move the awareness to the middle and then upper back, then the shoulders, noticing again the subtle movement with the breath.

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Be aware of the whole of the torso and the breath.

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Bring awareness to the upper arms, then the lower arms, moving to the hands, then fingers and then thumbs.

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When the mind wonders gently bring the focus back to the body.

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Transfer the awareness to the shoulders, moving to the back of neck and throat, noticing the breath.

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Bring the awareness to the head, the back of the head and then the face.

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Explore the sensation of the face, cheeks, nose, and lips.

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Move the focus to the tongue, jaw, ears, eyes, forehead and then the scalp.

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Bring the awareness back the belly and notice again the movement with the breath.

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Move awareness to the buttocks, hips, pelvic floor, upper legs and then the thighs.

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Moving then to the knees, lower legs, ankles, feet, soles and top of feet and then the toes.

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Expand the awareness to the whole body and the breath.

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Notice how the body moves with the breath.

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Finish the practice and bring the awareness back to the surroundings.

3 Mindful movement This is practised standing, or can be adapted to seated or lying, generally lasts 1-20 minutes: •

Follow the sequence of movements and breathing whilst inhabiting the body.

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Begin by standing with the feet hip distance apart and knees soft, shoulders relaxed and arms hanging by sides.

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Feel the contact between the feet and the floor.

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Notice and tune into the breath, beware of the breath in and out.

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Aim to move in time with the breath (avoid changing the breath to the movement).

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Gently turn from the waist, allowing the arms to be lose, move mainly from the hips.

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Gently stop and return to the start position.

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Lift arms to shoulder height, rotate the arms to face the ceiling, lift hands towards the ceiling/sky.

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Lower hands to shoulder height and rotate hand back to the floor and slowly lower the hands.

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Return to the starting position (resting in standing).

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Repeat above one arm at a time, right followed by left.

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Notice the sensations of the body and check in with experience.

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When the mind wonders gently bring the focus back to the movement and the breath.

(Source: Adapted from Breath Works3)

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