September 11, 2013

From Thinspiration to Fitspiration

The Internet is a place to connect and find like-minded people.  The Internet offers a place to belong for some, a place to gather information, to learn. The Internet provides information about starving yourself, speeding up your metabolism, tips on burning more calories and photoshopped inspiration to stay thin and fit. Wait, what?! 

Over the past several years there has been a surge in websites that provide support for an eating disorder. Proponents of these websites would argue that an eating disorder is “a lifestyle choice.” Using pictures and quotes, the followers of these pro-ana or pro-mia websites encourage each other to maintain their disorderly eating behaviors and fight the guidance of family, friends and health professionals.

Recently, Lewis and Arbuthnott (2012) decided to explore how these websites were found. After choosing 26 pro-eating disorder (ED) terms, they utilized Google AdWords Keywords in February 2011 to study the frequency of pro-ED related searches. Their results indicated that there are 13 million searches annually on Google alone (Lewis & Arbuthnott, 2012)!  Pro-ana was the most common search term, with thinspo and thinspiration close behind. 

What is even more alarming is that there is a new villain in town, fitspiration. Fitspiration has not been scientifically researched at this time, however it is a close relative of thinspiration. Fitspiration includes images and quotes that are meant to motivate people to exercise more frequently and with more intensity in order to obtain a muscular physique (i.e. fit). Almost everyone on a social networking site has seen these images, so I will not repost them here, I will, however, provide a brief description. The images generally do not include a person’s head or face and instead focus on abs, gluts, chest, and thighs. People in the images are generally thin, toned, tanned, and photoshopped. Quotes are included that consist of statements such as:

Pain is weakness leaving the body.
Stop saying “I can’t”. You can, you just choose not to.
Obsessed is a word the lazy use to describe the dedicated.
Fit is not a destination. It is a way of life.
Would you rather be covered in sweat at the gym or covered in clothes at the beach. 
Making excuses burns zero calories per hour
First you feel like dying, then you feel reborn. 

Some of these quotes have been around for awhile, I remember my own swim coach in high school repeating the first quote listed. Inspiration is not new, but how it is being used on the Internet and on social networking sites is new. Feeling inspired to exercise is one thing, but berating yourself, comparing yourself, and purposely ignoring your body’s pain signals is another. 

Since there has not been any research on this topic, I cannot say what damage the fitspiration blogs, posts and website are causing. I predict that frequent visitation to these forums will lead to lower self-esteem, self-doubt, disorderly eating and exercise behaviors, and disconnect from the body.  Similar outcomes have been found in research on exposure to thinspiration (Jett, 2008). 

I recommend a mindful approach to both eating and exercise. Having a relationship with your body’s physical needs can lead to inspiration and motivation to choose health. If you do not have any pre-existing medical conditions, your body will let you know when it needs movement and when it has had enough. 

One way to combat the proliferation of fitspiration and thinspiration is to share your opinion. You can start here! 

August 26, 2013

How to Find a Therapist

Many students, friends and family members have asked me about finding a therapist. There are a lot of confusing acronyms, terms, and approaches to treatment. For the general public it can be overwhelming to even start the process, let alone figuring out who or what you need. The following guide is meant to help ease the process of finding a therapist.

How do I find a therapist who takes my insurance?

Most insurance companies have a link on their website for you to search for in-network providers. An in-network provider is someone who has a contract with your insurance company and has agreed to accept payment from your insurance. There are some websites that help with searching for providers within a certain insurance company such as Psychology Today or ZocDoc. If you are looking for help with a specific problem, for example an “eating disorder,” you could search in Google for “eating disorder therapist.” This will give you a list of other search tools, such EDreferral. EDreferral allows you to search for therapists in your area who specialize in treating eating disorders. This same technique works for any mental illness such as depression, anxiety, ADHD, etc. 

Let’s say you found a therapist you really connect with, but they do not take your insurance. Your insurance plan may have out-of-network benefits. You can check by calling your insurance company and asking them about out-of-network benefits for mental health. Be sure to ask the following question: “what percentage of the fee will you reimburse me for?”  Most insurance companies will only reimburse a certain percentage of what they consider an acceptable rate. For example, your therapist might charge $125 per session, but your insurance company may believe $65 is an acceptable rate and your insurance plan may only reimburses 50% of out-of-network fees, you would only be reimbursed for $32.50 of the $125. Every insurance company and plan is different, therefore it is important to ask lots of questions, especially before the bill comes in the mail.

Do therapists offer reduced fees for students, military or low-income families?

Most private practice therapists accept sliding scale. This means they will accept a reduced fee based off of the client’s individual financial situation. For example, a therapist may charge $125 per session, however if the client is unemployed or a student, the therapist may charge a reduced fee such as $100 or $75. Other therapists base his or her fee off of the client’s yearly income. Each therapist has a policy about the fees his or her business can accept, however not all therapists advertise their policy. Potential clients can always ask about sliding scale options during the intake call. 

What is the difference between a MFT, LCSW, and LPCC?

The Board of Behavioral Sciences oversees the licensing of MFTs, LCSWs and LPCCs. Their website provides more information about the differences between these three professionals. 

Contrary to the title, Marriage and Family Therapists (MFT) can and do work with individuals as well as families and couples. MFTs have a masters degree and are trained to focus on how interpersonal relationships affect mental health and can treat all diagnosable mental illnesses.  Professionals with a Master of Social Worker (MSW), may pursue a clinical license. Licensed Clinical Social Workers (LCSW) are trained to provide therapeutic services and provide social resources to individuals, couples, and families. Licensed Professional Clinical Counselors (LPCC) have a masters degree and are trained to work primarily with individuals. They can work with families and couples if they have completed additional training beyond their masters. 

If I want a therapist should I include psychologists and psychiatrists in my search?

A psychologist may have a Doctor of Psychology (PsyD) or a Doctor of Philosophy (PhD) in Clinical Psychology or Marital and Family Therapy. Psychologists provide treatment for individuals, couples and families. Additionally, psychologists are formally trained to give and analyze psychological testing.  Psychiatrists have a Doctor of Medicine (MD) or a Doctor of Osteopathic Medicine (DO). They can prescribe medication if they find it medically necessary, however they may or may not provide counseling during a session. Psychiatric appointments can be anywhere from 10 minutes to 60 minutes depending on the psychiatrist. If you are looking for a psychiatrist who provides clinical counseling make sure to ask about his or her approach during the intake phone call. 

Aside from a psychiatrist, all of the above professionals are possible therapists that can help with a range of mental illnesses. When looking for a therapist or psychologist, try to focus more on their level of experience and their specialities.

Should I be looking for a particular style of therapy?

The most well known treatment is Cognitive Behavioral Therapy (CBT). While CBT is a provenly effective approach, there are a range of treatments that have also been proven to effectively treat mental illness such as Dialectical Behavioral Therapy (DBT), Acceptance Commitment Therapy (ACT), and Eye-Movement Desensitization Reprocessing (EMDR). The general public does not usually know the difference between all the possible treatment approaches. When choosing a therapist I recommend considering location, cost, speciality, and your connection to the therapist.

Norcoss’ (2011) meta-analyses highlight the therapy relationship as the main contributing factor to successful treatment. Ask yourself, do you feel accepted by the therapist? Do you feel comfortable sharing your personal information? Can you trust the therapist? If not, do not be afraid to look for another therapist. 

Overall, it is important to ask questions throughout your search for a therapist. Starting therapy is a courageous step that can be eased by having information and knowing what to expect from your therapist and your insurance company. 

January 20, 2013

Tedx: Dare to Make Peace With Your Body

Dr. Divya Kakaiya is the Clinical Director and Founder of the Healthy Within treatment program. Her personal battle is against the current dieting paradigm propagated by the media today. Her talk challenges us to think more holistically about what health really is.