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Eating Disorders and Athletes

Eating Disorders and Athletes

Most athletes are highly competitive and self-disciplined and will go to great lengths to excel in their sports. Their personality traits and characteristics typically reflect obsessive-compulsive tendencies in the way in which they approach their sporting pursuits. The pressure they often experience with the expectations of teammates and coaches as well as spectators may make them at a higher risk for developing an eating disorder than the average person. Perhaps the self-imposed pressure to achieve their goals as an athlete makes them more predisposed to develop an eating disorder. Furthermore, athletes who compete in sports that emphasize appearance or require speed, lightness, agility and quickness (i.e., runners, ballerinas, and cyclists) are at higher risk for developing an eating disorder than are non-athletes or athletes in sports that require muscle mass and bulk (football players).

Eating disorders are most common in athletes that participate in the following sports:

  • ballet and other dance
  • figure skating or other types of competitive skating
  • gymnastics
  • running or marathon runners
  • swimming / diving
  • rowing
  • horse racing
  • wrestling
  • race car drivers

Both men and women athletes are susceptible to eating disorders, although the female gender has a higher prevalence. However, our clinical experience and recent studies have shown that more male athletes are seeking out treatment for their eating disorders. More specifically, the male heterosexuals in general have often been misdiagnosed and are more likely to pursue treatment for a formal eating disorder. The three most common formal eating disorders found in athletes are:

·         Anorexia Nervosa

·         Bulimia

·         Compulsive Exercise

The real threat to an athlete with an eating disorder is the extreme stress placed upon the body. The compensatory behaviors such as restricting, binging, purging or excessive exercise have detrimental effect on performance. The process of binging and purging results in loss of fluid and low potassium levels, which can cause extreme weakness, as well as dangerous and sometimes lethal heart rhythms.

The Female Athlete Triad
Women athletes with eating disorders often fit into a condition called the female athlete triad, a combination of:

·         Depleted energy levels (eating disorders)

·         Menstrual irregularities (amenorrhea which is defined as the cessation of at least 3  consecutive menstrual cycles)

·         Weak bones (increased risk of stress fractures and osteoporosis)

The relentless pursuit to become thin and attempt to reduce body fat or adipose tissue by extreme measures has a negative impact on exercise performance and introduces a host of health complications. Nutrient deficiencies and fluid/electrolyte imbalance from restrictive caloric intake can lead to increased risk of fractures, illness, loss of reproductive function (amenorrhea) or infertility complications and serious medical conditions such as dehydration and starvation. The medical complications of this triad involve the majority of body functions and include the cardiovascular, endocrine, reproductive, skeletal, gastrointestinal, renal, and central nervous systems.

Many athletes mistakenly think they’re not at risk for osteoporosis because they exercise and exercise is known to strengthen bones. However, research shows that exercise alone does not prevent bone loss. Irreversible bone loss starts within six months to two years after the loss of menses. Comorbidity diagnoses such as depression, anxiety disorders and obsessive-compulsive disorders often coexist with formal eating disorders.

Warning Signals of an Eating Disorder

A number of factors predispose an athlete to developing an eating disorder. Risk factors include the following:

  • Preoccupation with food and weight
  • Repeatedly expressed concerns about being fat
  • Pressure from influential people (coaches or parents) to lose weight to improve sports performance
  • Increasing criticism of one’s body or distorted body image
  • Over involvement in sports, with limited other social and recreational activities
  • Frequent eating alone or social isolation
  • Personality traits that are genetically predisposed such as perfectionism
  • Higher levels of stress, anxiety and depression which can be genetically predisposed
  • Training outside of scheduled practice times or more than other athletes on the team
  • Use of laxatives or diuretics
  • Trips to the bathroom during or following meals and purging
  • Continuous drinking of diet soda or water
  • Compulsive, excessive exercise
  • Poor performance
  • Complaining of always being cold
  • Training even when sick or injured
  • A traumatic event
  • Consistent injuries

 

Divorce / Death: Closing The Chapter of The Book of Life

The process of letting go of unhealthy relationships through divorce or loss is quite challenging. However, closing this chapter in the book of life allows one to move forward and make healthier decisions. Thus, divorce and death are similar in that both require a sense of loss. The ones who address this process are the ones who give themselves permission to experience the bereavement and to become more introspective. Most individuals are fearful of facing this enormous emotional suffering.

Clearly, one may not be able to control or manage every single event that occurs within the life cycle. Many tragedies or disappointments occur that may create a sense of loss or sadness. As an illustration, when our love ones die we typically experience grief or bereavement which takes approximately eight seasons or two years to work through this process. The various stages of grief are as follows:

  • shock and denial
  • anger
  • depression
  • bargaining
  • acceptance

The following story illustrates how death may impact all ages:

A very young boy named Aaron had a beautiful black Labrador retriever named Onxy that he had known since birth. At the tender age of four, the dog suddenly died and this was Aaron’s first experience with grief. Initially, he was in shock and he could not accept that his dog had died. In hopes that Onyx would return home, he continued to provide food and water for him on a daily basis for approximately three weeks. Once he experienced the initial stage of grief, he began to become increasingly agitated and irritable. For example, he tested limits with his parents and was easily provoked to anger which is the second stage of the grief cycle. During the third stage of the bereavement, he experienced childhood depression whereby he isolated from his playmates and family and suffered from a decrease in appetite and disruptive sleeping pattern.

Finally, his parents took Aaron along with a bouquet of beautiful flowers to Onyx’s grave and explained to him the process of death. He asked all of the precious questions that children often ask about death such as “Can he breathe under the ground and will he go to dog heaven?” It was at that point that Aaron began to move towards the last stage of grief which was acceptance. His parents proposed the idea of allowing him to select a new puppy and he was thrilled! His response was the following:  “I don’t want just one puppy, I want 101 puppies with big black spots on them.” As the story goes, Aaron did get only one new Dalmatian puppy!

Divorce / Grief and the bereavement cycleLikewise, as adults the grief and bereavement cycle can be very painful. The sense of loss may also create a fear of embracing new relationships due to fact that one may worry about experiencing another loss. Similarly, when an individual experiences a separation or divorce it is also perceived as a significant loss that one may or may not be able to control. Studies show that approximately 91% of divorces and termination of relationships are initiated by the female gender. According to some studies, a women’s standard of living goes down 73 percent after divorce while a man’s goes up 42 percent. Currently, divorce statistics are rising, but a couple of years ago it was estimated that one out of every two marriages end in divorce. Why is the divorce rate soaring at this time?

Perhaps one explanation would be that women often report that they feel deprived of affection that they cherish and are clueless about what to do with this issue. Another theory is that the divorce rate may be blamed on the women’s movement. Clearly, women have become more independent emotionally and economically and they feel more financially able to terminate a bad marriage. Men often report that they harbor resentment towards their spouse because they have tremendous financial responsibilities for the family. Men also acknowledge that being committed and monogamous is very difficult. Moreover, extramarital relationships exist in American marriages in more than half or more of all distressed couples entering into counseling. In some cases, it may improve the relationship or it may lead to separation or divorce.

However, the list of consequences that couples often report that stem from an extramarital affair are as follows:  violation of trust, guilt, dishonesty or lies, anger depression, humiliation, anxiety, regret and remorse, disruption of careers, sexually transmitted diseases, unwanted pregnancies, jealousy, and/or separation and divorce. If the consequences are so severe, why do individuals risk having an extramarital affair? Simply, most individuals report that the extramarital affair allows them to have unmet needs in their marriage be met in their affair. Men are more likely to seek out an extramarital relationship due to the fact that their sexual desires are not met in their marriage. Whereas, women are more likely to seek out an affair due to the lack of intimacy in their marriage.   Therefore, males often report that they are more devastated if they discover their wife is having an affair due to the emotional attachment that she may develop with her partner. In addition, the stigma and shame that once existed regarding divorce seems to be more acceptable in our society.

Aside from the aforementioned reasons, both genders will hopefully learn to take more responsibility for choosing a more compatible partner and learn to meet some of their own emotional needs. However, it is important to examine various reasons for the decision-making process and to take responsibility for exercising poor judgment. If someone has been in an mentally or physically abusive relationships it would be helpful to take a closer look at why that individual elected that particular partner and why they were not attracted to a healthier partner.

In other words, look in the mirror at yourself instead of picking up the magnifying glass and pointing the finger at your partner. In the process of psychotherapy, it is typically effective if the individuals gains insight into their own personal issues and choices versus focusing on what is wrong with others. After all, you are the one that chose your partner and you are the one who is accountable for future choices that you make in interpersonal relationships.

The Monday Morning Blahs and the Sunday Night Blues

Do you ever have the “Sunday Night Blues” or the “Monday Morning Blahs?” Do you find yourself living and working for the weekends? It is important to find joy in the journey and incorporate some pleasurable activities, such as enjoyable hobbies during your weekdays, so that Eating Disorders and Stressyou can mange your stress. Pick up a copy of your favorite author’s new book on a Tuesday evening or spend the evening browsing the bookstore and buy yourself a latte and a  biscotti. Establish a movie night where you watch movies and order take-out and lounge in your pajamas.  Thus, improving your time management and scheduled events improves your stress management.

Individuals who know they have some control over their time management usually have less stress. One way to be in control is to incorporate more Type B personality traits into your lifestyle. Incorporating a more laid-back attitude will help safeguard your mental and physical health as well as replenishing yourself with leisure time such as taking time for yourself each day. Plan an occasional mental health day, such as a day of vacation during which you pamper yourself with a long walks, a facial, a massage, or playing with your frisky kitten, or just relaxing in your robe and slippers all day and watching old movies.

Identify your personal stressors by completing a stress inventory such as the Stress Map by Essi Systems. An inventory will pinpoint areas that are creating stress and will educate you on how to manage your stress more effectively. Examine your assessments and the charts. Identify areas that are particularly stressful for you and design a plan on how you will introduce change and be proactive. Learn to become more assertive and less aggressive in your communication style.

When people are assertive, they usually get their requests and needs met more often than when they are aggressive. One becomes assertive when one stands up for their rights in such a way that the rights of others are not violated. Eleanor Roosevelt once said, “No one can make you feel inferior without your consent.” Assertiveness implies that one can state their preferences without using accusatory statements that may be interpreted as blaming the other party. “I” statements such as “I would prefer to see the comedy instead of the drama. Assertive people express themselves without being self-conscious, accept compliments in a comfortable manner, and respectfully disagree with someone regarding an issue. Learning to say no and clarifying issues is also another manifestation of being assertive. WOMEN QUOTE: “The sign of a true lady is learning how to decline a dinner invitation without making an excuse.” One can be very gracious and say something along the lines of  “thanking for thinking of me, but unfortunately, I will not be able to join you” instead of “ I have to wash my hair and do my nails on Saturday.”

There are four basic interpersonal styles of relating to others: aggressive style, passive style, passive-aggressive style, and assertive style. The aggressive style is where one may raise their voice inflection and make demands and accusatory statements and the individual often does not consider the feelings of others. This particular interpersonal style often alienates others and is counterproductive. The passive style is where one does not communicate their needs or preferences and will often times aquiesence to avoid making waves. Girls who develop anorexia nervosa are often times very passive because they want to please others and do not want to ruffle anyone’s feathers by being assertive. Lastly, passive-aggressive is a style of relating in interpersonal relationships whereby one attempts to induce guilt or “pay back” another person by passively doing something to hurt that other person. An example would be to give someone the silent treatment because you are angry with them but you cannot find a way to express your anger in a direct manner.

Change stressors, such as moving across the country, starting a new job, or building a new home, are extremely challenging. Remember to allow yourself time to adjust to the changes, and try not to introduce too much change at one time. For instance, do not change to a new school system, train a new puppy and experience a breakup in a relationship in the same month.

Five Destructive Choices That Individuals Make In Choosing An Unhealthy Partner

Mistake Number One:couple

When an individual assumes the role of the victim repeatedly in relationships he or she may continuously choose an unhealthy partner.

Mistake Number Two:

When an individual is attracted to a partner who reminds them of someone whom they had an unhealthy relationship with in their past that was dysfunctional.

Mistake Number Three:

When an individual has not fostered positive self-esteem and independence they may select a partner who also has low self-esteem and is very emotionally dependent.

Mistake Number Four:

When an individual rescues a partner like a wounded bird and attempts to fix their problems they may later harbor resentment toward that partner.

Mistake Number Five:

When an individual compromises their own personal integrity and code of ethics by not being loyal to oneself or to their partner.

It all Begins In the Kitchen!

Most of our entertaining and socializing at parties takes place in the kitchen! Is it the wonderful aroma of smelling the delicious food cooking that attracts us to the hostess or host in the kitchen? Many individuals enjoy sipping fine wines and conversing with their friends in the kitchen. Perhaps this is a comfortable climate that allows one to relax and unwind.

Eating Disorders and Low LibidoSimilarly, many partners report that the hugs they receive from the refrigerator such as midnight snacking may serve as comfort food and trigger emotional eating. However, many couples report that they avoid sexual interaction if they do not feel good about their bodies. The libido may be decreased for the male if there are depleted levels of testosterone and the female may experience a decline in sexual desires if there are decreased levels of progesterone. Both genders may have a decrease in their hormonal balances if there is chronic stress in their lives. Furthermore, a symptom of stress is typically an increase or decrease in one’s appetite. Therefore, this process may lead to sexual dysfunction in the relationship.

Healthy Steps For Improving Body Image, Intimacy, and Sexual Functioning

The first step to improving your perception of your body image is to improve your self-esteem. When one builds positive self-esteem, they are more likely to be more accepting of their bodies. Secondly, it is important to recognize that weight management issues are not all about one’s behavior. For example, some individuals are genetically predisposed to be at a higher weight than what may be suggested by the governmental and medical charts. It is essential to practice healthy habits such as exercise and eating healthfully, but genetic factors play a significant role in one’s body weight and type. Thirdly, each partner needs to be accountable for their own health habits and to attempt to achieve a healthy body image. Power and control issues may often create conflict, passive-aggressiveness, and is typically not beneficial in terms of weight management.

Furthermore, it is important to be cognizant of the fact that our bodies and metabolic rates gradually change through the aging process. Perhaps being supportive to one another about this aforementioned issue may build more intimacy in the relationship.

Step One:  Forget about the perfect body image for yourself and your partner.

Step Two:  Omit power and control issue that lead to a battleground of conflict.

Step Three:  Healthy and balanced nutrition is the spice of life.

Step Four:  Initiate healthy habits for healthy beginnings such as an exercise program.

Daily Mindfulness

1.    When you first wake up in the morning, before you get out of bed, bring your attention to your breathing. Observes five mindful breaths.breathe

2.    Notice changes in your posture. Be aware of how your body and mind feel when you move from lying down to sitting to standing, to walking. Notice each time you make a transition from one posture to the next.

3.    Whenever you hear a phone ring, a bird sing, a train pass by, laughter, a car horn, the wind, the sound of a door closing—use any sound as the bell of mindfulness. Really listen and be present and awake.

4.    Throughout the day, take a few moments to bring your attention to your breathing. Observe five mindful breaths.

5.    Whenever you eat or drink something, take a minute and breathe. Look at your food and realize that the food was connected to something that nourished its growth. Can you see the sunlight, the rain, the earth, the farmer, the trucker in your food? Pay attention as you eat, consciously consuming this food for your physical health. Bring awareness to seeing your food, smelling your food, tasting your food, chewing your food, and swallowing your food.

6.    Notice your body while you walk or stand. Take a moment to notice your posture. Pay attention to the contact of the ground under your feet. Feel the air on your face, arms, and legs as you walk. Are you rushing?

7.    Bring awareness to listening and talking. Can you listen without agreeing or disagreeing, liking or disliking, or planning what you will say when it’s your turn?

8.    Whenever you wait in a line, use this time to notice standing and breathing. Feel the contact of your feet on the floor and how your body feels. Bring attention to the rise and fall of your abdomen. Are you feeling impatient?

9.    Be aware of any points of tightness in your body throughout the day. See if you can breathe into them and, as you exhale, let go of excess tension.  Is there tension stored anywhere in your body? For example, your neck, shoulders, stomach, jaw, or lower back? If possible, stretch or do yoga once a day.

10.    Focus attention on your daily activities such as brushing your teeth, washing up, brushing your hair, putting on your shoes, doing your job. Bring mindfulness to each activity.

11.    Before you go to sleep at night, take a few minutes and bring your attention to your breathing. Observe five mindful breathes.

Heart Health in the Treatment of Eating Disorders

Interview with Dr. Nina Radford, M.D.

Cardiovascular Medicine Department, Cooper Clinic

Please define your credentials and role as the cardiologist for Cooper Aerobic Center at Cooper Clinic. What clinical services do you provide for patients?

I have served as a staff cardiologist at Cooper Clinic for 11 years. My credentials include:

Heart Health in the Treatment of Eating Disorders

Diplomat, American Board of Internal Medicine, Internal Medicine
Diplomat, American Board of Internal Medicine, Cardiovascular Disease
Specialist, American Society of Hypertension,
Testamur, National Board of Echocardiography
Diplomat, Certification Board of Nuclear Cardiology

We offer cardiovascular consultations, resting and stress echocardiography, resting EKG, treadmill exercise stress testing and coronary CT angiography.

As you probably know, February is heart health month and why do you think this is important to acknowledge this?

February is Heart Health Month. I think it is important to acknowledge this to remind people of two important things. First, heart disease is a common cause of death in the United States. Second, and more importantly, we have a great deal of control as individuals over whether we develop heart disease based on the lifestyle choices we make.

According to the American Heart Association 2013 Statistical Update, coronary heart disease alone caused ≈1 of every 6 deaths in the United States in 2009. In 2009, 386,324 Americans died of coronary heart disease. Each year, an estimated ≈635,000 Americans have a new coronary attack (defined as first hospitalized heart attack or coronary heart disease death) and ≈280 000 have a recurrent attack. Approximately every 34 seconds, 1 American has a coronary event, and approximately every 1 minute, an American will die of one.

Despite the fact that we know we should not smoke cigarettes, among Americans ≥18 years of age, 21.3% of men and 16.7% of women continued to be cigarette smokers. In 2011, 18.1% of students in grades 9 through 12 reported current cigarette use.

Despite the fact that we know physical activity is good for us, 32% of adults reported engaging in no aerobic leisure-time physical activity.

I think February is the perfect time to reexamine those New Year’s resolutions that are focused on health and refocus our efforts in changing those lifestyle habits that are unhealthy!

It appears heart disease is on the rise for women in particular and can you please report the most current research and the reasons why it has become so problematic for the female gender?

Actually, deaths for cardiovascular disease are going down in both men and women. Women are lagging behind for a number of reasons. Historically, women have been treated less aggressively than men but this is changing. Many women now are treated with all the lifesaving therapies that are available to men. Women tend to be about ten years older than men when they develop heart disease at which time they many have multiple other health problems. This is why prevention of heart disease is so very important in women.

Please describe why you think it is important for patients from The Walker Wellness Clinic who are suffering from a formal eating disorder to seek out a cardiac assessment?

Patients with eating disorders can develop a number of cardiac complications including low heart rate (bradycardia), low blood pressure (hypotension), abnormalities of heart valve function (mitral valve prolapse), fluid collection around the heart (pericardial effusion), heart rhythm abnormalities (extra, rapid or irregular heart beats), depression heart muscle function and changes on the resting EKG (QTc prolongation, first degree heart block, ST-T wave abnormalities).

Can you give one specifics on what the cardiac assessment includes and what the findings may reveal with the test results?

The cardiac assessment begins with a thorough history, cardiovascular examination and resting EKG. Depending on what signs or symptoms are discovered, a resting echocardiogram may be performed to look for valve disorders, heart muscle dysfunction or fluid around the heart.

What recent empirical research can you give us in regards to treating eating disorders and cardiac complications?

It appears that many of the cardiac changes seen in patients with anorexia are reversible. In one recent study of 173 adolescents diagnosed with anorexia nervosa, who were hospitalized, had echocardiograms before and after treatment which were compared to echocardiograms of healthy adolescents of the same age. Thirty-seven percent of the anorexia patients had fluid around the heart (pericardial effusion). The pericardial effusion resolved in 88% of these patients after weight restoration (Kastner et al., Eur Child Adolesc Psychiatry. 2012;21(1):15-21.)

The treatment of eating disorders is incremental caloric feeding, which can have its own intrinsic cardiovascular risk (refeeding syndrome) manifested by arrhythmia, tachycardia, congestive heart failure, and sudden cardiac death. This is a more common occurrence in an in-patient setting.

Can a patient recover from cardiac issues if they are able to restore their normal weight range and normalize their eating? If so, how does this happen?

This likely occurs because of restoration of normal electrolyte balance (salts in the blood), normal fluid balance in the heart and normalization of levels of various hormones which become disordered under the stress of malnutrition.

What does the future research show for the role that cardiologists will play in the treatment of eating disorders?

Cardiologists will likely remain an important consultant on the medical team treating eating disorders. This will be particularly true as the patient with anorexia ages into midlife and issues regarding the development of atherosclerosis (hardening of the arteries) come into play.

As part of our comprehensive treatment program at Walker Wellness Clinic, we collaborate with highly competent cardiologists, physicians, and OBGYN’s to ensure the medical stability of each one of our patients. We continue to communicate with the team of medical professionals throughout the treatment process in order to monitor the physical health of the patients we serve.

Eating Disorder Recovery – Stages of Change

Eating Disorder Recovery Stages

Pre-Contemplation (resisting change): This is either a denial of the problem, or an awareness of the problem with an unwillingness to change.  Patients do NOT want to change.  Patients feel HOPELESS.

Contemplation (change on the horizon): There is an awareness of a problem, an understanding of the pros and cons of change, yet there is a fear of change.  Patients weigh the pros and cons of change and say things like “I know I should but….”

Preparation (getting ready): There is a clear awareness of the problem and the need to learn how to change.  Patients may experiment with small changes.

Action (time to move): The person starts to terminate unhealthy behaviors and develop new, more positive behaviors.  Patients need praise and motivation.

Maintenance (staying there): action behaviors are practiced and continually reinforced until they become automatic and last for an extended period of time.  Discouragement about ‘slip ups’ may halt the change process.  Patients must stay motivated.

Snacking is Healthy

Eating between meals can be somewhat frightening, especially when it is against your “food rules” to eat unless it is a meal time. Snacking can be a great addition to anyone’s diet. It is okay to be eating every 3-4 hours—many times we go longer than this between meals! Snacking allows you to go from one meal to the next without becoming famished. It also helps maintain your blood sugar levels which will help keep your metabolism running and your energy up!

  Snacks with Fruit

Healthy Snacking for Eating Disorder Patients

– Fruit and yogurt parfait: layer fresh fruit with your favorite yogurt flavor. Top with granola
– A fresh fruit salad: your favorite seasonal fruits, a splash of lemon juice, and honey
– A fruit smoothie: blend a handful of frozen fruit with yogurt or milk and ice
– A large handful of several different dried fruits with nuts and chocolate chips

 Snacks with Vegetables

– Celery stalks spread with peanut butter and topped with raisins
– 1 cup of fresh vegetables (carrots, bell peppers, broccoli cauliflower, etc) dipped in dressing.
– 1 tomato sliced in half with melted cheese, salt, and pepper on top
– A cup of tomato soup

   Snacks with Calcium

– Yogurt sprinkled with almonds or walnuts and your favorite cereal
– A cup of hot chocolate made with milk, instead of water
– Cottage cheese with pears, peaches, or tomatoes
– Frozen yogurt with granola and berries
-Pudding with Cool Whip and crushed Vanilla Wafers

  Snacks with Grains

– Whole-wheat crackers and peanut butter
– Whole Grain Nachos: 1 serving of whole grain crackers with salsa and melted cheese on top
– A bowl of your favorite cereal
– A whole grain frozen waffle with berries
– A wheat tortilla with cheese or deli meat
– Pita bread and hummus
– A bowl of popcorn
– A couple of small cookies & milk
– A handful of pretzels/baked chips

Leave a comment if you have any other healthy snacking ideas!

Recovery from an Eating Disorder: A Journey

Recovery from an eating disorder is possible!Recovery from an eating disorder, like life itself, isn’t a race. As long as you look at recovery as a continuum, rather than a single destination or a cure, there is plenty of reason to hope. Recovery’s leap of faith eventually blossoms into a willingness to explore new places in yourself, relationships, and your world. Some steps on the journey are slow and tentative, others come more easily-but each can be taken only one step at a time. Recovery is progress, not perfection, and that is the formula that holds the real promise of peace. Recovery is hindered when you judge yourself harshly by someone else’s progress; your problems are the only ones you can ever fully understand- and that itself is a challenge. On the other hand, a healthy comparison with someone doing well in recovery can inspire you and show you that recovery is achievable.

Recovery is not a result of choices among alternative paths offered by the present, but a path that is created -created first in the mind and will, and created next in behaviors. The path to recovery is not some place you are going to eventually reach, but one you are creating with each step you take. The paths are not to be found, but made, and the activity of making them changes both the maker and the destination.

There are often times in the process of recovery when you may tell yourself you have had a “bad” day after one single incident or event. This negative thought leads you into a cycle of self-defeating thoughts and behaviors, which transform the “bad” incident into a bad hour, day, or even week. Try to look at your slips in recovery as bad moments, not bad days. For every bad moment you have during the day, think of a positive moment you had during the day. You will find that you may not have really had a bad day at all, just a day filled with good and “not so good” moments.

 
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