In this podcast Tabitha Farrar explains why she believes that neural rewiring is a crucial and often not understood aspect of achieving full recovery from a long-term restrictive eating disorder such as anorexia nervosa, bulimia nervosa, binge eating disorder.

This podcast is about neural rewiring and why, for an adult with an entrenched eating disorder, it is a crucial part of recovery in my opinion.
 
Full recovery = Nutritional Rehabilitation PLUS Neural Rewiring
 
So often, the rewiring part is missed, and that is all very well with children and teens or people who have not had an eating disorder for a long time, but for those of us with long-term entrenched behaviours, nutritional rehabilitation alone is not enough. We have to rewire those neural pathways otherwise we fall right back into them. In this podcast, I explain how.
Transcript thanks to Marie

Hello there, welcome to this week’s podcast. This week it’s just me, I’m going to chat to you and what I’m actually going to talk to you about this week is rewiring neural pathways and trying to explain what that actually means. It’s explained very thoroughly in the book that I published this year called Rehabilitate, Rewire, Recover and the title kind of gives that away a little bit. Rehabilitate, Rewire, Recover and what that stands for is my belief that in order to make a full recovery from a long term restrictive eating disorder you have to do 2 things: You have to nutritionally rehabilitate your body and you have to neurally rewire your brain.

Now the book that I wrote was damn long so this is going to be a much shorter version of that and not quite as in depth but here we go. Nutritional rehabilitation. We know that energy deficit is what triggers an eating disorder in anybody that has the genetic predisposition for one and so nutritional rehabilitation kind of reverses that. It takes you out of energy deficit. It can also help your body start to recover from the long term effects of malnutrition. So that’s super important. You can not fully recover from an eating disorder when you are still in an energy deficit. And that I think most people get. I say most, I wish everybody but I think most get that in order to help somebody recover from an eating disorder you have to get them out of energy deficit. I think that this is employed really well in say family based treatment for eating disorders. Where refeeding is the primary and most important aim of the treatment. But I think what gets a little bit missed in what we are talking about in adults who have had long term eating disorders is this second part, and that’s the neural rewiring part.

So, whenever you do something, whenever you do something repetitively, you start to form neural pathways in your brain. And that’s why our brains are so fantastic because they learn. It’s this learning that enables us to start doing things automatically and then intelligence is freed up to do other things when you are doing things relatively automatically. There’s a reason why at school my maths teacher made us repeat and recite our times tables and there’s a reason why if you asked me what’s 2 times 2 my brain automatically goes 4 and I don’t really have to thing about that. And that’s and engrained neural pathway. My brain has learned that. And usually that is absolutely wonderful and makes us really smart, and makes humans be able to do amazing things but sometimes, it’s not particularly helpful. And when you have a restrictive eating disorder, and you have been doing the behaviours and responding to particular thought patterns for years and years and years and years, then neural pathways form. And this is why we describe somebody as having an entrenched behaviours

So for an example of an entrenched behaviour or entrenched thought patterns maybe, me, every time I would see food or look at food I would instantly start counting calories in my head. So that’s a really interesting example, counting calories. I think a lot of people do this and a lot of people are annoyed by the fact that they do it when they are trying to recover. But you don’t really understand after a while well why is this happening so automatically? Well with that counting calories, your brain remember is super smart and when you first start counting calories, it might be to actually start with you thinking and intending I’m going to eat less and therefore counting calories is relevant information for me. And after years and years and years and even when you’re in recovery, and even when you’ve decided to actually eat more and want to get better, I don’t want to do this any more and your brain still counts calories and you’re trying to work out why is this still happening? It’s driving me crazy.

Just think of all of the years that you’ve counted calories. And then think that every time you’ve done that, your brain has learned that counting calories is important. Your brain thinks that the information that it gets when it counts calories is really important, vital information and the reason that your brain thinks this is because after you’ve counted calories for all these years, your behaviour has changed as a result of what that calorie count gave you. And so are brains are informed by our actions. If for example, you counted calories and then you did nothing with that information, your brain is going to consider that information as redundant, however remember for years, you’ve been counting calories and that information has informed your actions, you probably ate less later as a result of it. Or you modified something or you changed something. The fact that it informed and changed your behaviour teaches your brain that counting calories is really really, really important information and that becomes neurally hard wired because you keep on doing over and over and over again.

The other thing that informs our brain is where we give our mental attention. If say the topic is wallpaper, I’m not at all interested in wallpaper, I’ve probably given the topic of wallpaper less than zero mental attention over the last 10 years. Probably over my lifetime. So therefore I’m not just sitting around thinking about wallpaper, because why would my brain do that? It’s not important to me, it’s not learned that wallpaper is important to think about. However, if I was an interior designer, I might think about wallpaper a lot. Wallpaper might be very important to my livelihood and my job. I’m sit around and think about wallpaper quite a bit.

When you have an eating disorder your brain that things like calories and exercise and all of these actually really incredibly boring topics that are swamped in our brains the whole time, you pay mental attention to these things and that teaches your brain that they’re important. So you can’t expect your brain to just suddenly stop counting calories just because you’ve decided that you want to recover now. Your brain has years and years and years of you teaching it via your thoughts, attention and via your actions that counting calories is incredibly important and that’s also the reason that when you decide to go into recovery and you decide, you know what? I don’t want to count calories any more! Your brains like, wait no this really important, you have to count this.

The reason that your brain thinks that it’s important is because you’ve taught it that, there’s nothing wrong with your brain. It’s just doing exactly what you trained it to do. All of the years, all of this attention on these things teaches your brain that they are vitally important so the neural rewiring process is also where we teach our brain that, you know what brain, I know for the last 10 years I’ve thought about calories every day, maybe for every minute of every day and I know that for the last 10 years I have counted every single calorie that I’ve eaten but now, it’s not important any more.

And your brain will kick up a bit of fuss because remember, you taught it that it was important so your brains going to be hang on a second, remember this stuff is really important and you’re going to be like, no no not any more brain no it’s not the rewiring process is sticky like that. And you have be so consistent and committed which is one of the things that I really try and help people with as a coach is that consistency and commitedness. Because it’s an alright world for just one day not allow yourself to count calories and for one day, if you do count calories not allow yourself to change your behaviour based on what that information gave you but that’s not going to do much.

You’ve had 10 years of days of doing the opposite. One day is not going to rewire your brain. However because your brain is super smart, consistency will actually lead to new neural pathways being formed and this is called neurogenesis and so what happens is a lot of the time when a person is in recovery, an adult is in recovery, nutritional rehabilitation as I’ve said, crucial, vitally important you can’t recover without that.

But often people will go into treatment centre and they will be referred, which is a wonderful thing, but there will be no neural rewiring involved and the sticky part about neural rewiring is that nobody else can do that for you. So if somebody puts a plate of food in front of you and tells you eat it and basically forces you to eat it that’s a great thing and it’s going to help you nutritional rehabilitate but no neural rewiring will take place there because you didn’t make any conscious decision and therefore your brain can learn.

There is a reason why in maths class your teacher didn’t just give you the answers to all of the questions. There’s a reason why your teacher sits there and makes you work it out yourself. That’s because that’s how our brains learn and so one of the crucial aspects of neural rewiring is that you have to be the one saying, you know what? My calorie count tells me that I’ve eaten more today than my eating disorder thinks that I’m allowed too but I’m going to make the decision to go out and get a doughnut or 10 right now and I’m doing that and I’m eating them.

That’s incredibly difficult isn’t it? But that’s why it’s important because it’s difficult because you are having to fight those entrenched and engrained neural pathways and in doing so you are building new ones. This is where many treatment models really fall short. Not addressing neural rewiring. And don’t get me wrong, it’s way better, way better to go to a treatment centre and get nutritionally rehabilitated but when you come out of the place, that’s when your work starts. That’s the neural rewiring bit and it’s pretty much as simple, if you want it in a nutshell of doing the opposite of everything that your eating disorder tells you to do. Doing the opposite of everything that feels natural to you because those are where those engrained, entrenched neural pathways have been formed.

So did I mention that this stuff is really hard?! It’s so difficult when your brain is convinced that you need to act in a certain way, it’s so difficult to actually do the opposite thing. It feels terrifying and that’s where most of our fear and anxiety comes from. It’s doing the thing that our brain has been trained, or not doing the thing that our brain has been trained that is very important and we have to do. The hard bit is following through with that consistency but it does get easier that’s the thing. If you can be long sighted to see this is going to be difficult right now my anxiety is going to be really high because I’m basically going against everything that my brain think is really important by it will get better and it does get better.

A lot of the time people can feel like they are in a real behavioural rut and also a thought pattern rut and that’s just because that’s what happens when a neural pathway is used a lot. It’s a bit like traffic, or if you imagine how sheep walk in a field and if all the sheep all walk in, they just follow each other and if they walk in the same line, they tread down that grass and it becomes a path and because it’s a path they keep following that path and those paths become really deep. That’s what neural pathways are like, the more traffic that neural pathway gets, then the more entrenched it becomes and the more you feel like you are really in a rut that’s difficult to get out. But you’re not. I mean you may be in a rut, that’s an entrenched neural pathway. But it’s not that you can’t get out of it, it’s just that it’s difficult mentally to do so.

But if you have that consistency and determination then you absolutely can do that. And so a lot of the time in recovery, what you need to work out is, well what support do I need in order to help me with this consistency. You know your eating disorder best, you know where it trips you up. You know yourself best and so you use that information to help you discover and work out what support you need.

Consistency, consistency, consistency and it will start to work. And you will feel absolutely hopeless and exhausted for a long time but it will start to work. What starts to happen, say for example with the calorie counting one, is when I realised this, realised what I had to do was allowing that calorie counting information to be relevant because our brains don’t continue to do something if it becomes obsolete our brains are far too smart for that. They don’t have the energy to give the attention to things that are obviously not relevant, so we have to make counting calories not relevant any more. How do you do that? You can’t expect your brain not to count calories just because you’ve suddenly decided not to do it any more. But it will learn not to if you don’t allow that calorie counting information to influence your behaviour and if you don’t allow yourself to place a lot of mental energy on that calorie counting.

So my brain would just tot up calories like I taught it to and then it would give me an you’ve eaten X amount of calories today that’s more than usual and instead of changing my behaviour to say eat less than I planned at the next meal, in order to show my brain that that information was not valid or relevant, I’d actually eat more at the next meal. Consistently. And then I got to the point where I realised that every time I counted calories the best thing I could do in that moment would just be to eat something, anything, whatever it was. Always have some chocolate handy, some biscuits handy and if I noticed my brain counting calories I’d just be like right, well I’m going to eat right now! That really helped me. The other part is not giving it a lot of mental attention. So as soon as I noticed I was counting calories I’d shut down those thoughts as quickly as possible.

I would yes, take action to negate those thoughts, that would be the eating part, whatever I was doing, where ever I was, put something in my mouth if I was counting calories. But I would also shut down the thought as quickly as possible, rather than dwell on it, rather than allow my brain to go over and over it. Because where our attention goes, energy flows and that’s actually something that my meditation teacher taught me. Where our attention goes, energy flows. Where you give your mental attention is where your brain learns where things are important. So not giving those thoughts mental attention.

That’s an example of rewiring and that’s the really important work that I think is missing a lot in treatment of adults with eating disorders. It’s not quite as relevant for a 12 years child who has had anorexia for 6 months and hasn’t got that neural network set up in their brain yet. Usually when somebody is young or is really is in the primary stages of an eating disorder, because neutral pathways takes a while to establish, the refeeding process alone will do the rewiring bit. Those of us who are adults and have had eating disorders for 10+ years, probably 2+ years, there are going to be neural pathways that need to be rewired as well.

You can’t expect the refeeding process to just rewire your brain. That actually is going to take energy and work and that’s what we need to do. And so that’s pretty much what I covered great detail in the book with lots of different examples. Often I get asked, well how long does this take? And I think that the simplest way that I can describe a lot of this neural rewiring bit is say if you were in a really bad relationship, a traumatic relationship or something. The day that you make that decision of I’m not going to be in this relationship any more, and you get out of that relationship, from day 1 of exiting that relationship, your life is going to be different, hopefully it’s going to be a lot better and you’re going to notice that incredibly and even those first couple of months are going to seem like massive freedom and gosh, things are 100 times better than they were when I was in this relationship.

So the initial, when we go into recovery, that initial big shift is huge and in that first year of recovery, many of us just feel like we’ve just done so much work and we’re radically different. But it’s still difficult. Now if you’ve exited that abusive relationship, although it might be radically different and much better immediately, it’s going to take probably 2 or 3 years before you’re completely over it. Don’t you think? Before you don’t cringe at certain things, or you don’t jump at certain things and you completely relax and the relationship doesn’t pop into your brain and you don’t notice it in your behaviours or reactions to people. It’s probably going to take a while and that’s what I think it’s like with the neural rewiring process when you’ve got a restrictive eating disorder.

When you make the decision to recover and you start eating a lot of food and you start doing the opposite of all these entrenched behaviours and thought patterns, immediately things are very much different and you’re just like, wow. But it takes really a couple of year for those neural pathways to go away completely so I think that when we start building new neural pathways, when we start doing the opposite of what our eating disorder behaviours are, we immediately start building new neural pathways but for most of us we find that in the first year or 2 it’s sort of fragile. It’s like you can feel that those old neural pathways are still there, and kind of beckoning you to come back down them because they were deep, they were entrenched.

So they’re still going to hang around and wait for you to slid back into them and that’s why I think for the first couple of years of recovery many of us have to be very careful with the things that we struggle with. So for me exercise would be the primary example here. I stopped exercising, I stopped the compulsive exercise. My life was immediately very different and felt just incredible and I felt like a 100 times different from when I was compulsively exercising but there is no way I would have been able to join a gym. You know what, I couldn’t even be friends with, or hang out with people who were heavy exercisers it was just too raw still. Those neural pathways were still there, I knew I would slide back into it.

Now, years and years and years later, I could go and sit in a gym all day and I would not be tempted to get on a treadmill. I can tell you that. I can have friends that run ultra marathons and it’s not going to affect me one bit, I’d be like all right you go for a run, I’m going to Wendy’s. And so I feel so, and that too a couple of years for me to really feel that solid. So I think that’s also really important thing to understand of this. So it doesn’t mean that takes a couple of years to rewire, I think that you can start building neural pathways as soon as you start to do a different behaviour but I think it does take a couple of years for those old entrenched neural pathways to really go away and die.

And so if you’re in recovery right now, of course nutritional rehabilitation, you know me, I think it’s the most important thing in the world. But you have to do the neural rewiring as well. If you’ve had an eating disorder for any length of time. And believe me, because your brain is so clever and so smart, it’s going to fight very hard to hold on to the things that you have trained it over the years are very important. In order to overcome that, you’re going to have to be determined, you are going to have to be incredibly consistent. You don’t get to take a day off from doing this. You’ll be back so many steps if you do that and so with that knowledge, have a think, what do you need to do in order to help yourself be successful here.

Don’t necessary stick to the, well this is what eating disorder treatment is supposed to look like. Have a think about you, yourself, you’re an individual. You have to rewire your brain, what can you use in your environment, in your support system, friends, family, professionals as well. What do you need in order to help you be as consistent as you really need to be because one thing I do know is true, is that if you do this work. It will work. And so many times people say to me, I can’t stop counting calories, I can’t do this, I can’t do that and then I say to them, well have you actually done these things, have you actually stopped changing your behaviour as a result of counting calories and if you haven’t, then how on earth can you expect your brain to stop counting calories when you’re still telling your brain directly from your behaviour that counting calories is relevant? Of course it’s not going to drop it!

And so if you’re feeling hopeless about recovery then probably don’t feel hopeless about recovery because now you might understand why some of the things haven’t been working and why your brain hasn’t been responding in the way that you want it too. It’s a bit like you’re trying to train a dog not to jump up, but it jumps up and you’re still congratulating it and you’re giving it a kiss for doing so. Of course the dog is still going to continue to jump up. Our brains are just products, highly trainable things, they are products of what we teach them so have a look at how you are still teaching your brain that the behaviours that you are trying to stop doing are important and relevant. And then a think about, OK, so what do I need to do to train my brain that these things are not, no longer important and they are no long relevant and if you can do that, your brain is really really clever it will respond. It will work this out.

So I hope that helped if you have any questions, you can always email me at info@tabithafarrar.com and you know podcast might be a bit spotty for the next month or two as I’m moving house and it’s quite a big project, the house that we’re moving too, very excited about it but it’s going to be a lot of things to organise and a lot of things to do and so I’ve also got two new puppies as well and I might just not record a podcast because I might just be in the back yard under puppies. I hope you don’t mind terribly, but I’m going to try and be as consistent as I can, I’m just setting you up for that they might not be every week for the next month. But when I’m moved in and when I’m settled we’ll be back to the normal schedule until next time, cheerio.

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