Interviews

Duke Integrative Medicine Creates Mindful Eating Program for Bariatric Patients: Interview with Sasha Loring, M.Ed, L.C.S.W.

By Richard Mahler

Sasha Loring, M.Ed., L.C.S.W., is a psychotherapist and health educator specializing in mindfulness meditation and associated with Duke Integrative Medicine in Durham, NC. She is also an independent consultant in stress management, meditation, and mindful eating, and has been teaching meditation for over 30 years in such locations as the Karme Choling and Shambhala Mountain meditation centers. Most recently, Sasha was instrumental in creating the 13-Week Mindful Eating for Bariatric Patients manual for eMindful and will be a member of the REMEDIES team from Duke Integrative Medicine answering questions about mindful eating techniques and mindful eating research. Sasha can be reached at sasha.loring@duke.edu. I interviewed her via telephone and e-mail during late July.

Richard: Tell me how you first became interested in mindfulness?

Sasha: It was 1975, and I was searching for something more meaningful than what I had learned in college. So, never having meditated, I naively signed up for a program that turned out to involve meditating 12 hours a day for a month. Even though it was one of the more difficult experiences in my life, I found it valuable enough to keep going. I've been practicing, studying, and teaching meditation ever since.

Richard: In what areas of mindfulness -- both personal and professional -- are you currently involved?

Sasha: On a personal level, I returned recently from an extensive leave from Duke University that I took for the purpose of pursuing meditation more fully. This included being in retreat for a year in the wilds of Cape Breton, Nova Scotia, and more recently in the mountains of Colorado for two months. I also was invited to teach meditation in several places around the United States.

Professionally, I often integrate some form of mindfulness training into my work as a psychotherapist and health educator. Mindfulness can help people become more embodied: in touch both with their emotional obstacles and their inherent wisdom. The open, nonjudgmental qualities that are cultivated with mindfulness training are a great help in recognizing, accommodating, and actually making friends with all aspects of ourselves.

Richard: What is the nature of your work at Duke Integrative Medicine?

Sasha: I work as a psychotherapist and also present workshops and lectures on topics concerning mental and physical wellbeing, guided imagery, meditation, stress reduction, and so on. Duke Integrative Medicine has a program called Executive Health, where corporate executives and other professionals are evaluated as members of a group or individually on all aspects of health. For that program I do health psychology/stress evaluations. I was also a group leader for a study using mindfulness as an intervention for Binge Eating Disorder, a project directed at Duke by Dr. Ruth Q. Wolever. The latter was successful enough to merit further research and programming of a similar nature, which Dr.Wolever is directing.

I am currently working on a 13-session educational program for people undergoing bariatric surgery. Research is showing that even though the surgery results in successful weight loss, those who had unaddressed “maladaptive eating patterns” before surgery will over time start this kind of eating again and gain back weight. The 13-session program specifically addresses this issue and will guide participants through some of the psychological and behavioral aspects of maintaining weight loss, using mindfulness as a base. It's designed to be used as an Internet class and will include topics such as The Power of Presence, Emotional Hunger, Making Choices, Positive Self Regard, and Principles of Weight Maintenance. The Internet aspect allows people who would not ordinarily have access to education and support to join in a class with a “live” teacher.

Richard: What are some of the basic ways mindfulness and eating connect?

Sasha: About ten years ago I was invited to teach meditation at Duke Diet and Fitness Center to people in residence for the purpose of losing weight. The more classes I taught, the more I realized that mindfulness was an excellent intervention for someone trying to change his or her eating behavior. The emphasis on awareness of what you are doing, thinking, and feeling in the present moment, goes right to the core of issues around eating. Before anything can change it has to be seen clearly. Seeing what is -- itself a courageous undertaking -- is at the heart of mindfulness practice. Mindfulness is also helpful in catching a harmful chain of behaviors at the beginning, where such behaviors can more easily be averted. The strong connection between mindfulness and healthy eating behaviors led me to create a program (and CD) called The Wisdom Path for Changing Your Relationship with Food: Guidance for Achieving and Maintaining a Healthy Weight. I've taught this in the community and for businesses, again using mindfulness to help people with weight loss.

Richard: What does research tell us about mindful eating?

Sasha: A new book is out called Mindfulness-Based Treatment Approaches: Clinician’s Guide to Evidence Base and Applications, edited by Ruth Baer. The Duke University study previously mentioned is described (in Baer's book) as a Mindfulness-Based Eating Awareness Training. In this study, mindfulness meditation is conceptualized “as a way of training attention to help individuals first to increase awareness of automatic patterns and then to disengage undesirable reactivity ... and to heighten awareness of potentially more healthy aspects of functioning.” Dialectical Behavior Therapy (DBT), which has a large mindfulness component, also is noted as an approach to eating disorders: “This version of DBT is designed to improve participants’ ability to manage negative affect adaptively and includes training in mindfulness, emotion regulation, and distress tolerance.” In addition, cognitive therapy has been successful in addressing depression and anxiety and a newer adaptation called Mindfulness-Based Cognitive Therapy is being looked at for binge eating. Another therapy approach using mindfulness is called Acceptance and Commitment Therapy (ACT), which emphasizes “nonjudgmental acceptance of thoughts and feelings while changing overt behavior to work toward valued goals and life directions.”

The basic premise for using mindfulness as a therapeutic approach is that eating problems often arise from a desire to escape from self-awareness. Mindfulness training provides a very gentle, gradual guidance into self-awareness at tolerable levels over time. This means awareness of our obstacles as well as awareness of our wisdom and capabilities for positive change.

Richard: Is there anything else you're involved in related to mindfulness that you'd like to discuss or direct us toward?

Sasha: For me, mindfulness is a lifelong experience, a gradual path toward sanity that takes daily practice. I've looked at all sorts of approaches for becoming a sane, open, and compassionate person. I've traveled widely, taken countless workshops, and so on. For me, meditation remains the most direct route for undertaking this journey. Fortunately I am able to be one of the Mindfulness-Based Stress Reduction program teachers here at Duke Integrative Medicine, so meditation is an integral part of my work life.

Richard Mahler is an independent editor, writer, and Mindfulness-Based Stress Reduction teacher in Silver City, NM.. Richard has published 11 books and written for publications such as the Los Angeles Times, Chicago Tribune, Los Angeles Daily News, Alternative Medicine, Miami Herald, San Francisco Chronicle, Albuquerque Journal, Toronto Globe and Mail, Houston Chronicle, and E/The Environment Magazine. You may contact Richard at rmahler@cruzio.com or visit www.RichardMahler.com.