You’re home right now with your family, but it’s not a cozy scene: someone in the house has an active eating disorder. The strong emotions, chaos, and conflict are amplified inside the home and it seems like no one can escape the anxiety and dread. Siblings are withdrawing from family life. As parents you are struggling to stay on the same page with one another. Meals and preparing meals is a disaster. Does any of this sound familiar? These are the kinds of stories I often hear here at F.E.A.S.T, and especially in times of crisis like the one we face now. Without the structure of school and appointments, without access to allies and providers, families are facing an unexpected and intense challenge. Here in this community we have tools to share that may help.
My first lesson in distress tolerance was from Nancy Zucker’s book Off the CUFF, where I learned about “staying off the emotional wave.” Before I learned that visualization I thought I was pretty good at handling my children’s emotions and my own. I considered it normal to feel and act more emotionally as my children’s emotions rose. It seemed uncaring, even poor parenting, to remain calm and unruffled when a loved one was in escalating anxiety. With this new way of looking at my role, I grew more and more able to be unflappable (okay, I may have faked it a bit at first) and effective. To my surprise, my children came back to a calm state faster and were more trusting of me afterward: I became a more effective caregiver.
Distress Tolerance is a powerful tool
In my experience, learning distress tolerance is one of the most fundamental and powerful tools for parents during eating disorder treatment and a heck of a parenting tool overall. I’ve personally found my own distress tolerance skills learned during crises continue to serve me so well in many parts of my life. In 2020 during the covid-19 crisis I am leaning on it hard, to be honest.
I know: distress tolerance sounds simple, but we all know it is quite hard to face an anxious, angry, loved one at home even in the best of times. It helps me to look at tolerating distress as active and powerful instead of weak and passive.
Distress tolerance is a parental superpower, not a lack of caring.
Modeling Distress Tolerance for our Families
The benefits of increasing our distress tolerance skills are many, but one significant positive is in modeling that skill to our anxious kids by having them see us doing it ourselves in the face of the pandemic. “Show, don’t tell” is a powerful tool. We are asking our ill family members to do very difficult things that cause very strong emotions. Showing them that we are able to do that, and even letting them know it is a challenge for us that we are not perfect at achieving, is loving and a teachable moment.
Tolerating Their Distress
We’re parents. We’re used to soothing, comforting, explaining, and fixing. It’s our job description. But with an eating disorder there isn’t any way out but through. There will be distress. Sometimes extreme distress. Avoiding distress and upset not only doesn’t usually work, but it can also turn us into tools of the eating disorder. It can make us forget that emotions won’t break us and that avoiding emotions like anxiety can make them grow. When we can accept and not react to or join in with our children’s distress we become a lighthouse in the storm.
Showing Leadership and Confidence
Eating disorders and the anxiety of challenging the behaviors and thoughts can create chaos in a home. Family-Based Treatment has shown that restoring parental confidence and authority in the home can be a powerful tool for regaining the confidence of our children. This authoritative parental stance also keeps the eating disorder anxiety from disrupting and distracting from recovery. When we increase our ability to tolerate our own distress and our ill family member’s distress, we can regain that leadership role in the family and the confidence of all family members that we are able to meet this challenge and chart the family’s course.
You’ve Done This Before
I often ask parents to remember when their toddler lost it in the grocery store. It was naptime, they were angry, you just need to grab some essentials, and little Ned is acting like a feral groundhog spinning in circles and screaming. You were exhausted and embarrassed by the scene, and you realize you should have planned it all differently, and you just want to disappear. But at some point you pick your little one up and put them over your shoulder and make your exit. You don’t yell at the child, you know it isn’t their fault, and you know it’s temporary. The horrible anxiety and acting out of eating disorder recovery is a lot like this. You don’t get on the floor and tantrum with them. You don’t sit down and explain everything. You get that they are overwhelmed and that it is your job to just move forward. To do all this you have to know your role, and practice distress tolerance. Even with a spitting mad teenager. Even with a spitting mad adult. They are unwell, and you’re the caregiver, and you are doing your job.
DBT and Distress Tolerance
DBT stands for Dialectical Behavioral Therapy, which is a type of treatment offered by therapists for a range of conditions, including eating disorders. Distress tolerance is one of the skills of DBT, but parents and other caregivers do not need to wait for or work with a provider to learn these skills. The better we understand these ideas the more we can incorporate them into how we support our anxious family members. We don’t need to become therapists to our families, but the vocabulary and concepts can be used to support the whole family.
- DBT Skills for Eating Disorders (Eating Disorders Therapy LA)
- Distress Tolerance Skills Worksheet (Therapist Aid)
- Dialectical Behavioral Therapy in the Treatment of Binge Eating Disorder (NEDA)
- What is Distress Intolerance? (CCI)
*A special note on TIPP, a DBT concept. “intense exercise” is a controversial idea when it comes to eating disorders and treatment. Since over-activity can be a symptom and a maintainer of eating disorders, it may not be a concept to use or share.