Craighead - The appetite awareness workbook: how to listen to your body & overcome bingeing, overeating, & obsession with food

Appetite awareness training (AAT) emerged from my years of research and clinical work helping people figure out how to feel better about the way that they eat and how they look. As I look back on my very first effort (I was a college senior leading a group for college women who wanted to lose weight for my honors project in psychology), I realize how radically I have changed the way I think about eating and weight. As I worked with (mostly) women, I came to the conclusion that the fundamental basis for the way I learned to treat disordered eating left much to be desired. The basis for cognitive and behavioral interventions for eating problems is to have the client self-monitor in a way that requires her to write down everything she eats each day. The purpose of this self-monitoring is to draw your attention to how you are eating so that you (with the help of your therapist) can figure out what is not working for you and can develop a way to eat that works better. There is nothing inherently problematic about self-monitoring. It is in fact the most powerful tool that anyone can use to change their own behavior. However, I came to believe that recording what one ate put way too much emphasis on the kind of food eaten and not enough emphasis on a persons eating decisions, which were, ultimately, what had to change.

Most clients who came to see me had already tried food monitoring in one form or another. Recording your food intake is regularly touted in current diet magazine articles as the most effective way to limit what you eat. Clients who were overweight and might have benefited from paying attention to the differential calorie content of different foods were often the most turned off by my request that they monitor their food intake; some refused to do it at all. Some loved food records but became too dependent on this external source of control; they gained weight whenever they werent monitoring very carefully. For my clients who were not objectively overweight, the food part of the monitoring often seemed irrelevant or it increased their distress and compulsivity around eating.

In the process of experimenting with alternative ways to help my clients pay more attention to what seemed important, I developed the intervention I call appetite awareness training. My clients responses have been overwhelmingly positive. Almost all of them report that they are more willing to do appetite monitoring and that it focuses more on what seems important to them. I have trained many other professional therapists to use this technique, and they have reported similar positive results. Therapists often tell me how much better they feel about asking their clients to monitor appetite rather than food.

To provide scientific support for AAT, my research team reported several initial studies (Allen and Craighead 1999; Craighead and Allen 1995). Our current work suggests that treatment for eating problems that is based on the principles of AAT is at least as effective as any other treatment that has been evaluated at this time, and is preferred by many of those we have treated. Craighead et al. 2002 evaluated AAT-based individual treatment for women diagnosed with binge eating disorder and found that over 80 percent had stopped binge eating by the end of treatment. None of these women reported that they would have preferred to monitor food only. A few indicated they were only willing to monitor appetite, because they had very negative reactions to monitoring food, but most indicated they were willing to include some limited food monitoring with the appetite monitoring the strategy you will see described in chapter 8 and appendix C in this workbook. A subsequent study (Elder et al. 2002) evaluated group treatment for college women with binge-eating problems and found a similar, very positive response to this model of treatment and type of self-monitoring.