“Everyone in the waiting area is staring at me. They all know I’m so fat and ugly.” Mary’s words choked out of her as she held back tears of embarrassment. Mary sat down and spent the first ten minutes of her session focusing on her breathing. I observed a noticeable calming in her body. Once calm, Mary reported just before her session, she had come across a memory of the day she found out her family was going bankrupt and how embarrassed she had felt. Mary was aware she had used the same word embarrassed to describe the waiting area and her family’s bankruptcy. Using this awareness, Mary named that feeling fat was protecting her from thinking too much about the trauma of her past.
Kimberli McCallum would describe Mary’s experience as, “Out of balance circuits mis-assign meaning and generating false stories to explain shifts, attributing any disappointment, difficult emotion or pain to issues such as weight, shape or food.” Mary’s brain was doing exactly what it is designed to do when perceiving an intense fear. Her amygdala recognized a strong emotion and went into autopilot, working faster than her hypothalamus to pump adrenaline into her body and help her. In that autopilot response, Mary had mis-assigned her intense embarrassment to everyone in the waiting area staring at her because she was fat and ugl
At one time or another, all of us have had our interpretations of experiences altered because our brains are hijacked by our amygdala. People with eating disorders are more likely to attribute these intense feelings to their body image. Mary had a diagnosis of anorexia. Understanding the brain’s function in how she experienced her body image was extremely beneficial in Mary’s treatment and recovery.
The amygdala is located inside the limbic system. The limbic system is the part of the brain where emotions are given meaning, and that meaning is assigned to a memory and attached to an association and/or a response. When we experience a strong emotion such as fear, anxiety, aggression or anger our amygdala will automatically activate. The amygdala sends a distress signal to the hypothalamus. The hypothalamus is like the command center of the brain. Once it receives the distress signal it activates the sympathetic (fight or fight) and parasympathetic nervous systems (rest and make sense of what is going on). All of this happens so quickly, often the brain’s visual center hasn’t had time to finish processing the event. If the emotion is strong enough, the autopilot response will only activate the sympathetic nervous system; a fight or flight response. If a bear were chasing after you, the ability of the amygdala to override and force adrenaline to help you run away would save your life. When the trigger event is a strong feeling connected to a traumatic memory, sometimes the hijack is less helpful. In Mary’s case, her brain perception of negative judgment of her body lead to restricting adequate calories. Building her awareness of strong emotions and learning to activate her parasympathetic nervous system significantly improved Mary’s treatment.
Mary’s experience of embarrassment in the waiting area was very real for Mary. Mary needed her feelings validated. It is not helpful to rationally explain to Mary that most people in the waiting area were looking at their cell phones and didn’t notice she was there. Her feelings of embarrassment were real. Her amygdala mis-assigned the feelings to negative body image issues. To help Mary reassign these feelings she needed to develop tools to help her brain activate the parasympathetic nervous system, (PNS). Once the PNS is activated a person can access their frontal lobe. It is the frontal lobe that helps with reasoning, decision making and planning, and helps mis-assigned meaning be reassigned. As in Mary’s case, once she used the tool of breathing, she was able to remember she’d been thinking about her experience with bankruptcy.
Mary had been using breathing techniques for several months. In the previous sessions she had reported being more aware of her feelings, and the events going on around her. She also reported more of an ability to calm herself down after experiencing intense feelings. Developing tools such as breathing to help relax takes time and practice.
Breathing exercises help the body calm down and the intensity of the feeling subsides. Deep breathing and focus on a calming or soothing visualization help the PNS activate and calm the body. Mary had learned and practiced visualizing the same soothing scene while she
breathed deeply to calm herself. Beginning her session with this tool helped her use her whole brain to process her experience.
Understanding the brain’s function can help empower clients to respond well to their intense feelings. When treating client’s diagnosed with eating disorders, understanding the brain’s function can help shift cognitive distortions in and out of the therapy office and lead to reducing eating disorder symptoms and positive treatment outcomes.