All
of what is below and all that appeared in the preceding 5 articles
is not presented as the cure for Obesity and Diabetes. Working
with the “Urge” is a great tool but not the only one
necessary. Amongst other things, patients may also need help with
determination and decision, they may need to correct misconceptions
about weight control that seem like truths to them, they may need
to learn what has and is causing their problem and they may have
to overcome the various ways they obstruct themselves from doing
what they know is needed for their health.
Working with the Urge is a way to offer specific suggestions
that are connected to the immediate, conscious experience of your
patients. It is about them, in a very personal way. Suggestions
that come from their Urge are not the one-size-fits-all, general
platitudes they’ve heard endlessly with no meaningful effect.
The suggestions are generated from each patient’s unique
experience.
You begin by helping them become aware of their experience of
the three primary phases of the Urge: Emergence, Resistance and
Resolution (control or out of control). You work with them to
come up with ideas to weaken Emergence, to strengthen Resistance
and to learn from Resolution. You form a working partnership.
By presenting the concept of the Urge to your patients you supply
a framework, a structure that directs their investigation. Their
experience clarifies the problem. Possible remedies can then occur
to either of you or perhaps as a result of a synergism. As described
in the first two articles of this series on the Urge, the more
you have investigated your own experience of your Urge, the easier
it will be to help your patients.
As you may recall from Article 3 of this series, (if you don’t,
re-reading it now will make the rest of this more meaningful)
we explore three dimensions to experience: Thoughts, Feelings
and Behavior. You can use these dimensions to help your patient
examine every phase of the Urge, beginning with Emergence. As
an example, lets take a patient who reports frequently losing
control at parties or at restaurants. To investigate the Emergence
of their Urge
* When you were at the party, when did you begin to feel pulled
towards eating poorly?
* What did you think as you realized you had an Urge?
* What did the Urge feel like? What was the sensation?
* Did it seem to be in any particular place in your body (feel)?
* What did you do just as you began to feel it (behavior)?
* How strong was it (feel)? Did it get stronger or weaker (feel)?
Your pt might say, “The smell of the food hit me as I walked
in the door. When I saw the buffet, I locked onto the pasta. I
knew it was homemade and one of my favorite foods in the whole
world. I felt the rest of me go kind of numb. Getting to the pasta
was all I really wanted to do. I acted normally, I was social
and polite but in my head the focus was on the pasta. I didn’t
want to look weird by going right for it. I knew I had to wait
to make it look casual. The Urge felt weaker when I had my back
to the pasta.”
You might say any but not all of the responses I’ll suggest.
Too many is too much to absorb. “Maybe your sense of smell
sets you up for an Urge. Be aware of this. If you smell good food
immediately watch for an Urge and protect yourself before it strikes.
Try to find out what food will be where you’re going. Rehearse
resisting it before you arrive. Getting "“ambushed"
makes control harder. Commit yourself to particular avoidance
of your favorite but harmful foods. Temptation is always more
difficult with foods you like. The numb sensation is very difficult.
It’s a cross between obsession and sleep-walking. Recognize
what it feels like to you and plan a procedure that will wake
you up. Talking to others about it helps, physical exertion or
movement helps, feeling fear from the consequences of eating it
helps and, strangely, focussed relaxation can also help. That
you could delay going directly for the pasta demonstrates more
control than you probably think you have. Can you expand that
or tap into it for a longer time? Keeping your back turned helped.
What other thought, feeling or behavior reduces the Urge? Experiment.”
The next Phase of the “Urge” experience is Resistance.
Once you recognize that the emerging impulse may have aspects
that aren’t good for you, what do you think, feel or do
to resist it at that moment? Most patients will be able to identify
some of what they think feel or do immediately upon realizing
that they have an Urge to eat what they know is not on their program.
Those that report not experiencing any form of resistance should
be asked to pay closer attention to the moment of Urge. Resistance
is always there. For examples of thoughts, feelings and behaviors
that are common expressions of Resistance, see Article 3.
Article 4 describes Resolution and gives examples of thoughts,
feelings and behaviors commonly associated with both Resolution-In
Control and Resolution-Out of Control. After the Urge has Emerged
and after there has been Resistance, you either achieve control
in the moment or you don’t. There are things to be learned
from both. Resolution is part of the struggle, not just the outcome.
A Few Other Hints
1) Make sure your patients use this material with realistic expectations.
Expectations that are too high result in a failure experience
even though the patient has gained skills in the process. They
already have much too much hopelessness.
2) Because it worked for you or another patient or it seems clever
/ insightful, doesn’t mean it will work for the individual
in your office.
3) Practice, practice, practice etc., etc. This is a skill. Some
people show natural talent and some seem like they’ll never
get it. Stay with the latter, you’ll be surprised.
If, reader, you’d like specific suggestions for responding
to specific experiences of your patients, write to this website
and I will try to help. The primary point here is to give you
a framework you can share with your patients. By using this framework
what has seemed to them to be the experience of Urges they can’t
control, now becomes an experience made of knowable pieces, with
each piece leading to a possible means of control. It’s
easier dealing with the parts than with the whole.
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