How To Get "Un-Stuck" in Your Eating Disorder Treatment

A common issue that I hear in therapy is feeling stuck in eating disorder recovery, or frustration with a lack of progress. Things like:

  • “I’ve been in therapy for years”
  • “I’ve gone to 4 different residentials and IOPs, but I’m still relapsing”
  • “I’m eating but I can’t get rid of the negative food thoughts and obsessions” 

Why do so many of us feel stuck when it comes to recovering from an eating disorder? I would argue that this is in part due to not using our “full brain” in recovery and in therapy. Surprisingly, we’re usually not using the parts of the brain that we need to when we just talk about our issues in traditional talk-therapy. There’s been a lot of recent buzz around “top-down” and “bottom-up” brain processing, and with it, some useful insights around how we can use this information to our advantage. 

“Top-Down” brain processing means that you’re using your frontal lobe, aka the “top” of your brain. This is the part of your brain that thinks, plans, and uses logic. In the eating disorder context, this looks like thoughts or judgments about food, body image, and comparisons. Most forms of therapy and recovery really engage the top of the brain. Interventions like CBT, being aware of maladaptive thoughts, and challenging those thoughts are great examples. 

Using our thinking and logic is great, but utilizing only this type of treatment modality is leaving out a lot of the other parts of our brain that can also help us recover. One thing that thinking and logic do not address are the underlying trauma or causes of those thoughts to begin with. This is where a lot of people get stuck. 

So, if the top part of the brain is in charge of thinking, what is the base of the brain in charge of? The bottom of the brain (the limbic system and the brainstem) is in charge of moving, sensations and senses, emotions, attachment, and behavior. If you have had trauma that influences your eating disorder, then that trauma is not going to be stored in the top part of the brain. Instead, it’s stored in the bottom of the brain because there is a heavy emotion attached to it. 

Thinking differently about your trauma, which works well with the top part of your brain, won’t be very helpful at the bottom of your brain. Why? Because when we feel we are in danger or experiencing trauma, we don’t go through our normal thinking and thought processes to get through it; instead, we just act. We don’t tell someone being chased by a lion to calm down and think about it instead of running. Thus, the language of the bottom of the brain isn’t thinking, it’s action. 

In order to engage this part of the brain, we need to speak its language. This is code for action — getting up and doing things. We need to re-teach the trauma part of the brain that everything is ok now, it’s safe, and actions don’t have the consequences we fear. This is also not a one time intervention – we need to be predictable and consistent with working through bottom-up brain re-processing. Predictability and consistency to your brain means safety. 

Not sure where to start? Here’s a list of actions that engage the bottom of the brain: singing, dancing, yoga, breathwork, music, art, cooking, playing with animals, and engaging the senses through aromatherapy, slime or clay. These activities bypass the top of the brain and instead work the bottom of the brain. They engaged the senses, balance, movement, and emotions all stored in the bottom of the brain (in the limbic system and the brainstem). Furthermore, these actions will apply well to treating all types of trauma, regardless of diagnosis or what you struggle with. For eating disorders in particular, it’s important to utilize the bottom-up processing with challenging rigidity. This means creating new, flexible, and spontaneous experiences in a safe environment, like acting, improv, poetry reading, and eating new foods. 

Research shows that the most effective forms of therapy use the whole brain, both top-down and bottom-up processing. For eating disorder recovery, this means challenging eating disorder thoughts (top-down) while also engaging engaging in grounding exercises using all five senses when stressed (bottom-up). It looks like self-worth mantras (top-down) while also singing a song about your self-worth (bottom-up). Some specific therapy modalities that include bottom-up processing are EMDR (taps into the brainstem and limbic system with eye movements) and somatic therapy (taps into the brainstem and limbic system with internal sensation focus) and mindfulness (taps into the brainstem and limbic system using deep breathing and meditation). 

Next time you’re feeling frustrated about feeling stuck, ask yourself what kind of communication you’ve been using to battle against your eating disorder and trauma. Instead of using just one part of the brain in recovery, we should strive to use the whole brain. Walking the walk along with talking the talk might be the key to change that you’ve been looking for. 

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