Podcast Transcript

Episode 55: Anxiety and Eating Disorders: Stories from the Field with Francesca Emma

[Bouncy theme music plays.]

Sam: Hey, I’m Sam.

Ashley: Hi, I’m Ashley, and you’re listening to All Bodies. All Foods. presented by The Renfrew Center for Eating Disorders. We want to create a space for all bodies to come together authentically and purposefully to discuss various areas that impact us on a cultural and relational level.

Sam: We believe that all bodies and all foods are welcome. We would love for you to join us on this journey. Let’s learn together.

Ashley: According to the National Institute of Mental Health, an estimated 19.1% of US adults had an anxiety disorder in the past year. While the National Comorbidity Survey for Adolescents shows that an estimated 31.9% of adolescents have had an anxiety disorder, and it is estimated that 31.1% of US adults will experience any anxiety disorder at some point in their lives. The Diagnostic and Statistical Manual defines anxiety as excessive anxiety and worrying occurring more days than not for the last six months about any number of events and activities, including work, school, personal life, and more. The anxiety and worry are associated with three or more of the following. Restlessness and feeling on edge, being easily fatigued, difficulty concentrating or mind going blank, irritability, muscle tension, and the last one is sleep disturbance, including difficulty falling asleep, staying asleep, or having restless sleep. Additionally, we know that the median age of onset is roughly 30 years. However, it is important to note that many individuals report having been anxious for years prior to their diagnosis. Genetics can account for about 30% of the cause of generalized anxiety, while the most common sources of anxiety in adults are family and health, whereas in children, it is reported that it is school and their performance. So why are we discussing this on All Bodies. All Foods? Because according to the National Eating Disorder Association, 48% of adults with anorexia nervosa, 81% of adults with bulimia nervosa, and 65% of adults with binge eating disorder have at least one co-occurring anxiety disorder. Anxiety often precedes eating disorders and may even persist after eating disorder recovery. These statistics do not include anything released on the spectrum of eating disorders, such as ARFID or OSFED. And it could be inferred that anxiety and other specified feeding and eating disorders overlap and intersect as well. Because of this, we felt like this conversation surrounding the intersection of eating disorders and anxiety was imperative. If anxiety can both precede an eating disorder and persist after recovery, then we need education and tools surrounding how to best care for our loved ones experiencing this combination. So we have invited specialist and therapist, Francesca Emma on the show to discuss how anxiety can impact our folks with eating disorders. Francesca has been practicing outpatient therapy since 2009. She received her undergraduate degree at Fordham University, and her master’s from Derners Institute of Psychology at Adelphi University. She specializes, but is not limited to, the treatment of those struggling with eating disorders, anxiety, and depression. Francesca’s approach is eclectic, depending on her client’s needs. And she works with a team approach, incorporating and communicating with other providers when necessary. Francesca is also available for the professional development needs in her community, and she holds a passion in educating others in mental health and reducing the stigma for future generations.

Ashley: Francesca, thank you so much for joining us today.

Francesca: Thank you. Thank you so much for having me.

Ashley: We were hoping that you could just kick us off today with a little bit of a background about yourself and what led you in the direction of focusing on working with those struggling with eating disorders along with anxiety and depression.

Francesca: Sure, so first of all, I want to say, it’s just such an honor to be here. Renfrew actually set my foundation for my education in eating disorders back in like 2009. So I started here. So it really feels full circle to be back here today talking with everybody. I began therapy, got into the eating disorder world, sort of just preemptively first job, a teacher that I had across the board in grad school, I loved the class, was very interested in it and put me forward in touch with Renfrew and I connected there. Through that time really grew and developed a lot of learning about what comorbid with the eating disorder and anxiety is just right up there on the top and like you said in the introduction It’s just across the board in the world right now and probably always, so there’s a lot of interest for me and sort of managing that. I consider myself an anxious person, so I think it’s good to know how to allow it to work for you, right, and that it doesn’t need to be all negative in that sense. So, you know, we talk about anxiety and when people think about it, they think it’s like just worrying and negative thoughts. And yes, it is that, but it really is sort of like an antagonist in our lives.

Sam: Yeah. Absolutely. I love that you admit that you’re an anxious person. I’m an anxious person too, so welcome to the show. I love having, I love when we can find some common ground, but I thought we could start with the basics here for our listeners, because I think the word anxiety gets thrown around a lot, and anxiety is like a natural part of the human experience, but then it can kind of go into the realm of being a disorder, but there’s also many forms of anxiety disorders, so can we start with what is, and how might it show up in our lives?

Francesca: Yeah, so a good analogy is sort of that hamster wheel. It’s that spinning and getting nowhere when we’re talking about this anxiety. So I’m going to go back to the Inside Out 2, I don’t know if anybody’s seen it. But the premise of the movie is that there is a character, a main character, Riley, and she’s experiencing a slew of emotions. And in the first movie, she’s a child. And those emotions are sadness, anger, things sort of basic. All of a sudden we get to this new movie and all the emotions are sitting there in front of a console and the console starts to light up and shake and the main character goes through puberty. And we all know there’s a time where lots of new stuff comes during that space. And I loved it because they started to introduce new emotions. And just, you know, all things aside, anxiety, it is very, very common for anxiety to increase during the puberty years. So we see a lot of teens, parents coming in saying, wait, my child would never like this, and all of a sudden that has sort of escalated. So in the movie, it looks like anxiety is helpful. It’s preparing the main character, it’s organizing her, it’s keeping her in line. But as the movie progresses, she experiences what looks like the panic attack. And in that moment, she has a really a lot of physical sensations that go along with it, and we start to see that it’s actually separating her from her core self, from who she truly is. And there we start to look at what anxiety actually is. So there’s that functioning anxiety, like I’m just an anxious person. And then it’s, wow, this is taking away from who I am as a person. And that’s where we really want to come in and look at the mental health treatment in those aspects. So various forms, whereas general anxiety, it’s on a spectrum, right? I’m just worrying about situations to I’m worrying about everything. But then there are things like panic disorder where we’re physically panicked in moments and that presents itself very physical like we see in the movie, right? There’s shaking, there’s increase in heart rate, there’s sweating, those types of things. Then there’s phobias, when we’re very specific, right? We’re worried about our health, we’re worried about height, and in those moments, we experience panic or we experience heightened anxiety where we’re not functioning, right? And then there’s PTSD, which is Post-Traumatic Stress Disorder. And that follows some significant life event. Traumatic doesn’t only have to be abuse, it can also be a great loss, something of that nature. And it can happen years later or it can happen right after. But so really when we look at what’s going on with the anxiety, we have to see how is it presenting itself.

Sam: Mm hmm. That’s so important. I love that you brought up that, you know, anxiety, there can be a, you know, a function to it. That I think that surprises people because a lot of people come to therapy and they’re like, “make all of my anxiety go away right now, please.” But would you be able to give some examples of the way anxiety, you know, actually can help us and it’s sort of like a normal part of existing.

Francesca: I think you can keep people organized, you can keep people prepared. When we’re anxious for something, we start to give ourselves thoughts about it more in-depth thoughts. So it allows us to do those things effectively. It’s that fully gray line where we’re looking, where we cross it to become obsessive, which is another form of anxiety. We talk about obsessive compulsive disorder, where those negative thoughts start to influence and it starts to influence our functioning of day-to-day life.

Ashley: Francesca, I’m curious, obviously, All Bodies. All Foods, we focus on disordered eating, eating disorders. I’m curious about the overlap of eating disorders and anxiety, which comes first? How does that present in the eating disorder timeline, et cetera?

Francesca: Yes. Okay. So this is a really big question because I think understanding this is sort of the basis of how we’re going to do treatment when we have the anxiety and eating disorder, kind of like the chicken before the egg. I think first it’s the eating disorders to me, the way I would describe them are they are, or it is a maladaptive coping skill. And that sounds so basic, but I think it really is a way that people who are struggling with eating disorders start to formulate when things are awry, right? They’re using their food and they’re eating. I think most people think it’s all related to body image and there’s usually a little bit more to that than body image. So when we’re talking about if the anxiety came first, you know, you have parents coming in saying, “my kid was always anxious” or people who come in and say, “I was scared to leave my mom, I was scared of heights, I didn’t want to do things,” and then all of a sudden had this developing eating disorder. They’ve used the eating disorder to manage that uncomfortable feeling and to try to control. “I’m going to control food when I can’t control any of these other feelings that are coming from my anxiety.” On the flip side, you have people coming in, “I was never anxious, I was never worried. This eating disorder manifested itself, and all of a sudden, I’m obsessively worrying about all of these things, food-related and non-food-related. Why is that happening?” Probably in those scenarios, there is something else before the eating disorder that has happened, whether it be a big loss, a trauma, some type of thing, and that the eating disorder is a way to cope, and that as a result, the negative thoughts of the eating disorder flourish into this anxiety state. I do this analogy of like angel- devil on your shoulder with eating disorders. I think the eating disorder voice, which we, you know, was coined in a life without ED book by Jennifer Schaeffer, I believe, and then, so in that book, you know, she talks about this negative voice sits on her shoulder, it’s constantly in her head. And so when that voice gets louder than one’s own voice, that’s when the anxiety starts to really increase. And that’s where we try to teach the clients and our patients who walk through the door, “how do I lower that voice so that my own voice can kind of come up?”

Ashley: Right, so to kind of expand on that a little bit, I think, there are going to be times throughout one’s eating disorder journey where the anxiety could spike based on certain things they’re experiencing. So I have a list of some things and I’m just curious if you could speak to these different intersections. Okay. So one, you kind of touched on this, but the intersection, of anxiety and food with someone with an eating disorder.

Francesca: Yeah, so that one’s a gamut, right? That’s a big one. I think it comes so much as simple things like what to eat, when to eat, who am I eating with? When a meal’s in front of me, how does my physical sensations in my body change as I’m trying to navigate the food because of that voice or whatever is happening in front of me? It’s also in the preparing, the preparing of food, seeing food, and we can’t, you know, one of the hardest things about eating disorders is we can’t, we need food to survive. So it’s a constant daily in our face, nonstop space. So the anxiety tends to really intersect in that world. And it also is the guilt after. So in the eating disorder, the anxiety can come, you know, while in recovery, especially, you know, we get people to start to refeed themselves and, you know, start to reduce their binging. And in all of these moments after, we see a huge spike in anxiety and guilt. “Why did I eat that? Why didn’t I eat that?” You know, it goes from both ways, right? It’s not just one way or the other. If we have a client who we’re trying to reduce binging with, it’s okay, “Why did I just binge” or “oh my god, I can’t believe I just binged.” Almost like a disassociation from self. And then as we reintegrate, we really start to increase that anxiety.

Ashley: Yeah, that’s making me think of I do this presentation for professionals that don’t necessarily work in eating disorders, and I talk about myths of eating disorders. And like one of the myths is it’s just a question of eating. And I’m like so much more. It’s so much more like just in you thinking about the prep, the preparation, who am I going to eat with? What is my space going to look like? Do I have to go to a restaurant? Will anybody be there with me? How am I going to feel after? I mean, it just kind of sounds like it really takes over.

Francesca: Yeah, and in my clients who are struggling the most or in the height of it, it is nonstop. It is literally 24 hours around the clock of that thought about food. Even if food is not the trigger, it’s constantly there while in the disorder.

Ashley: Okay. So another one, what about the intersection of anxiety and appearance?

Francesca: So I think we’re going to be flooded right now, especially with social media with comparison. So it’s as simple as getting dressed, right? The fact, the physical act of getting dressed, there’s so much body dysmorphia that coincides with eating disorders that just getting up in the morning and getting ready, right? There’s a huge spike in anxiety for people. It could be dependent upon what they ate or what they didn’t eat the day before and how that’s making them feel today. It could be dependent on if they stepped on a scale, right? We have clients who are stepping on scales excessively and then that number translates into how they look. And so getting ready, it’s comparing themselves with others, it’s going shopping, right? Trying to go shopping, trying to do any of these things that should be fairly easy to do that really just spike tremendously during the time when they’re in disorder and anxiety.

Sam: Yeah. Mm-hmm, it reminds me of a group we used to have that, well, when COVID hit, we had to pause the group, obviously, but I think it’s happening again at the residential level where a group of residents, when they were ready, they would go to try on clothes in the dressing room. And it really took time to prepare for it and have a plan and a strategy and how am I going to tolerate my emotions. And it was really powerful when they were able to actually go and do that, and I think it’s just so important to get that practice because it’s like little things like that in life that can really throw you off in recovery.

Francesca: Right, and I think that those having like a support system to be able, I mean, it’s great that they had a group in real life trying to connect clients with, who can you do that with that feels comfortable? For some people, it’s, I need to cover a mirror for a little bit while starting this process and then get myself to the space where I can become accepting. It really depends where you are in the disorder in that moment. And in all of this, it’s like anxiety check in between, like, where’s my level? Give it a one to 10, right? Find the things that are ones and twos and compare them to the things that are tens and really check in with yourself during that because that will make you more accountable to what that feeling is in a moment.

Ashley: Yeah, that’s awesome. Okay, what about the intersection of anxiety and social life?

Francesca: So again, I’m going back to that social media poll because I think there is, especially in the younger generation, but across the board, this like left out feeling that occurs is the social space. So, social online world, we see a lot of like, “I’m feeling left out, I wasn’t there, I’m not involved in this.” So anxiety starts to really play on what they’re seeing. And again, that’s not even a real world, but it is what they’re seeing. And that’s a lot of times, because they’re so focused on the meal, or someone is so focused on the meal, or the food, or what’s happening, or how they’re physically feeling, that then they’re not feeling connected in the moment socially. So they start to isolate, because it feels scary or they start to really ruminate on conversations they had. “Did I say too much? Did I not say enough? Did I, was they looking at me funny? How is that happening?” And because of all of that, then again, that goes back to leading them to just be like, “I want to avoid all of these social stuff because it doesn’t. It’s making me too anxious.” So the social base and the anxiety really interlaps. I see it a lot when we’re at the height of the eating disorder. And even the recovery part, as well, because as we’re starting to feel better, if we enter these situations that make us feel uncomfortable, our anxiety starts to spike and that makes us scared, “What if we have to reintegrate or what if we go back to these eating disorder behaviors or thoughts?”

Ashley:  Right, right. And that, I think, speaks to how groups or support groups, you kind of mentioned that, especially in recovery, can be so helpful, because we’re not the only ones having. What I’m noticing is that as you’re talking, the anxiety, the eating disorder voice is just like spinning, spinning, spinning, spinning, spinning constantly. And so if somebody can get in a place to be in a group or be among the others who are having a similar experience, perhaps that can help normalize and quiet.

Francesca: Yes, normalize it. Yes, 100%. I think it’s really so helpful. And I think in all of that anxiety, it really is that like let’s normalize the feelings and really put a name to it.

Ashley: Yeah. Okay, anxiety and self-confidence. Where do you see that overlap?

Francesca: Yeah, I think again, it is that not good enough feeling. So, so many times women and men will walk through that door struggling with the eating disorder and just coming down to, “I don’t feel good enough,” whatever it is, good enough, you know, smart enough, this enough, that enough, and it’s all roaming into that self, which we talked about in the beginning, like, the anxiety and the eating disorder both put themselves and separate the core cell from the person. And so it’s just, it brings it down. It really does. So I think as a therapist, I know one of my main goals is to have someone walk out my door with a decrease in anxiety and an increase in self-confidence because that is really the key to being able to manage the anxiety after, you know, whether it’s in and after, but really in that moment, it’s just such a powerful, powerful thing.

Ashley: Yeah, I think the idea of like ego strength, increasing that ego strength, there’s so much that can come from building that self-confidence with a client. Like so much more can dissipate when we build our self-confidence, you know?

Francesca: Yeah, I mean, it really comes down to that space of making your voice louder. If we go back to that voice, that angel voice has to get louder. And the power that comes with that is tremendous.

Sam: I think the trickiest thing in this culture is that we’re told that the way to build self-confidence is to like work on your appearance. And I think that that’s where a lot of people, their mind goes when they think about self-confidence. It’s like, well, I have to be happy with how I look. And it’s surprising when they discover in treatment that self-confidence is like learning how to sit with your emotions and learning how to be assertive and it’s like, “whoa, I had no idea that those things were even connected.”

Francesca: Yeah, one of my biggest questions I ask in the beginning of treatment and then I ask it in between and later is what is your favorite thing about yourself and what is your least favorite thing about yourself? And it will shock you that least favorite obviously is easiest for most people to point out. And it’s almost always related to looks. And then we get to their favorite thing and they’re like stuck and saying, “well, I don’t like the way I look. So I don’t know, there’s not anything.” And some people say, “oh, it’s my hair.” And I have to really say, but wait, “what about like your character? What about the type of person you are? What would your friends say is their favorite thing about you? They’re not going to say your hair. They’re going to say that you’re trustworthy or that you’re, you know, accepting or that you’re humorous.” Those are the qualities that, and people don’t, they almost feel like, well, I didn’t even think of that.

Sam: Right. Wow.

Francesca: I know. So I think it really, yeah, we have to connect.

Sam: That’s so big. Yeah, it’s like an Ah-Ha moment in therapy when that happens.

Ashley: Okay, Francesca, last one. Well, really, did I miss any intersections? When we’re thinking of eating disorder, anxiety, where else do we see it intersect?

Francesca: I think you did a really good job covering most of that, and it also interlaps. One other one that sparked me is health. I see a lot of in the eating disorder, health anxiety or health and anxiety intersecting in this big way, and it’s like positive and negative. It can be how sick am I? Am I sick enough? What will the doctors or caretakers think about me? What’s the right thing to say? If they’re scale oriented, it’s what will the number be? And that anxiety that stepping on that scale will do. And there are so many ways now, like there’s blind weights and there’s scales that send their weights to their providers, so there are many ways around that. But I think, and patients who struggle with anorexia specifically, like I want to be sick or I want to be thin, but I don’t want to be thin enough where I need a feeding tube or where I, you know, my heart’s going to be hurting. And so there’s these spaces where that anxiety really kind of that black and white thinking kind of really goes into that space.

Ashley: I did just think of another one, anxiety and exercising or movement.

Francesca: This is actually, I would say this is kind of a complicated one too, because I think for some people exercise is a coping skill, and it can be a good coping skill, you know, it induces our endorphins and makes us feel good. But then it’s also symptomatic for so many of our clients. So it’s really how much do I exercise? Is this enough? And when they can’t exercise, what do I replace this with? That gives me that same feeling. So yeah, there is definitely an increase in exercise. I love when I see recovery oriented and I’m bringing exercise, but exercise doesn’t mean I’m riding my Peloton at top speed and not stopping, it means I’m going for a walk with my dog. Or my best friend and I are going to go outside and stretch. It has to really open up and spectrum what exercise can be. But yes, the intersection is definitely there, nonstop all day. I have one client particularly that I’m thinking of that it’s really hard to separate and find that other placement in that space and knowing that it makes me feel good but it’s also symptomatic, is anxiety provoking in and of itself.

Ashley: Right, exactly.

Sam: So there are folks with eating disorders who are navigating this anxiety with food, with their body, with exercise. The list goes on and on. And then I’m thinking on top of it, anxiety about school, work, the election, climate change, like, I mean, you know, who knows, anything really. I’m curious, what’s your experience with helping clients who are not only dealing with the anxiety connected to the eating disorder, but then the anxiety connected to the world?

Ashley: To living life.

Francesca: To life, right? And that’s, we all experienced that. I think in those moments, it’s again, going back to, and I don’t want to be too repetitive, but finding adaptive coping skills. Like what are the things that are our escape and make us feel good outside of the food? And I think, you know, there are times when it’s going to be things that are totally outside the box for us, right, but not being constantly connected is another way. I think that’s really important in that instance. So for people where the whole election is driving them and driving, take it off your phone, right? Take the news notification off of your phone. So sometimes it’s just simple things that can be avoided. Things with school, it’s really, you know, a pros and cons list. How important is this? What are the important parts of this? And what are the parts that we can’t control and are not affecting, right? Like we can’t affect that and then separating ourselves from that space, but really just flooding them with adaptive coping skills because the less that they can rely on the eating skills or negative coping skills with the eating then the more they can rely on things that make them feel whole, that’s where they’re going to be able to kind of push through those moments and get through that space. For patients that are really struggling or anybody really struggling with their eating, sometimes we have to look at higher levels of care, and escaping in a way that let me you know school is providing so much anxiety on top of the eating disorder and I’m not functioning I need more, right” And maybe that’s that step out not that we can always step out I have to be realistic about it but there are moments where really is necessary to do that step so that we can kind of take a time out, focus on that eating disorder behaviors and getting that, and then time back in so then we can build those adaptive coping skills.

Ashley: I’m just sitting here thinking, we all know it’s an election year. And it just, I know you’re saying like, take it off your phone, right? I, it was drilled into me when I was in college, I think that like, you have to be a good citizen and the way you’re a good citizen is to vote and to pay attention and to blah, blah, blah, blah, you know? So do I hear you saying, Francesca, that we can still be good citizens and take those notifications off of our phone?

Francesca: We absolutely can. I think at the end of the day, you know, we need to look at the big picture. How much is this affecting our life? Being a good citizen is also being healthy, right? And being able to give back to the community your best self. And we’re not able to do that if we’re being flooded with these negative thoughts. I think that we get our information from places that are resourceful and good. And that when we notice, hey, this is too much. Take that time out and be a good citizen elsewhere.

Ashley: Yes, give yourselves permission to really just take a break from it.

Francesca: I think it’s give yourself permission to take a break from anything that’s too much in life. We’re really setting boundaries for ourselves. Our health is our priority and we can’t be our best selves until we are healthy, and that’s mentally, physically, across the board. So taking the boundaries and setting them where we need is super important. And I think a lot of struggle I’ve seen in the world of eating disorders and my clients with their inability to set that boundary or to struggle with that boundary, and for a slew of reasons, right? And that’s something we process in therapy, but setting even little ones like taking notifications off or limiting your time, those things will make big impactful changes for you.

Ashley: Yeah. Okay, I kind of have another question. I was on your website, I was looking around and one of the things I noticed that just sat so sweetly with me, I just loved it, was the little banner that ran across your website that says, ‘you are not alone. You are not alone.’ I just kept seeing it. I’m so curious because this is clearly like your passion, eating disorders, anxiety, depression, like this is where you work. Why that message and what makes it so important, especially for somebody with anxiety?

Francesca: Really, it’s simply just that you’re not alone. I think that, you know, I’ve come up, we’re really, we live in this world where we are constantly shown images of perfection, of extraordinary things. And essentially, even though we live in this, supposedly connected worlds, I think I said before, we’re more socially disconnected than ever, than anybody. So I think it’s so important to do things like this. I really am an advocate for spreading awareness. I do professional development, all of that, because I want the word out there. And there’s a lot of mental health or there’s a lot more mental health awareness now than there was in my generation. I’m going to age myself now, but I think that it’s never enough because people are still wanting to show themselves as this perfect image. And until we can break that barrier and just say, hey, this is normal life, we’re not alone, join the group, listen to this podcast. Like the work that you are doing is amazing because people are listening to this and taking their walk or going out and doing what they’re doing and saying, it’s like a breath of fresh air. And so I do, I want people to come to my site and be able to be like, I’m not alone, I’m not alone. I’m normalizing this, right? That’s essentially my goal in being in mental health and being in this field, is I want this to be normal and allow people to walk in my door and be like, I’m going to be my authentic and raw self. And there’s nothing wrong with that. Right?  And there literally is nothing wrong with it. And to know that there’s millions of people who are like, I don’t think I’ve ever had a person come through my door who’s been like, I’m totally not anxious as an adult. I’ve never been anxious in my life. You know, it just doesn’t. My seven year old has told me that. But not, you know, I think that we underestimate the amount of people, and even with eating disorders, like we label it disorder, and there are so many women in general, just a bad relationship with food and with their body. And so again, normalizing that, it doesn’t have to be labeled a disorder, but it’s still not normal the way that you’re thinking and obsessing and these thoughts that are going through it. And I want that to just be common practice and that we can all like be with our girlfriends and talk about it versus talking about our number on our scale.

Sam:  Yes. So switching gears a little bit, let’s talk tools. Cause I know there’s so many people listening that are like, “okay, this is all great, but what do I do?” You know, so you work with these clients who not only are in eating disorder recovery, working on their eating disorder, but also dealing with an anxiety disorder. So a little peek behind the curtain, what’s happening in session? What interventions do you put in place to help your clients?

Francesca: I think that clients who are presenting to me with active eating disorder behaviors, I always work on the behaviors first. I will consider myself eclectic in that I have a psychodynamic background. I want to find the source. I want to explore all those things and process that trauma, but in the here and now, I want you to be healthy and safe. So walking through my door, I’m always trying to find the skills of what makes me feel good that I don’t have to use my food to do, right? Or I don’t have to let my anxiety kind of take it. And we start with the normal things, like I think every body should journal or you know meditate or safely exercise and you know sometimes it’s so much of taking a break and showering or self-checking in, you know, what’s my day like in the morning versus what’s my day like in the afternoon. Those are all practices that we see we can read about online we hear about and they’re good. But also connecting to like what are the things that make me happy is a big one that I do in the door because so I’m thinking back to how a young woman who was brought to me by her mother. She was applying for Ivy League schools. She was going to college and she wanted to be Ivy League. Never had anxiety before this, was definitely a perfectionist categorized, but never really functioning stressors with anxiety, really functioning very well. And she sort of got to this place, she had her eye on this one school and she really unraveled. Mom brought her in, her anxiety is through the roof. She’s not eating, like it was a lot. And she really couldn’t even connect to what was going to make her happy anymore. Everything was right or wrong, black or white, not good enough. So we ran the gamut of all of the sort of traditional, we’re going to do yoga, we’re going to meditate, we’re going to take a walk, we’re going to reach out for support. And then as I was trying to really engage her in this, like what makes you happy, like let’s explore this, she went back to… Well, I asked her what made you happy as a kid? Let’s just go all the way back since we can’t grasp it now. She talked about her love for art. So we started to reincorporate art. We said, all right. I said, let’s draw. Let’s paint. Let’s do these things. And she was, at first, “that’s so baby-ish.” I said, “let’s give it a shot. It can’t hurt.” For her, art was still subjective. So there wasn’t this good art banter, which really worked in my favor. But as she grew in this, she started doing this artwork that she felt like at peace is how she would describe it. And I’m like, “okay, well then that’s, you’ve touched in, you’ve tapped into something that makes you feel good.” So we started to tie this along her most anxious stage. She built a little area in her room where she would just disconnect and do her artwork. And she started to utilize that. And all of a sudden she was able to, now listen, not magically disappear anxiety, but really take a breath and reduce it. And she felt like she was able to walk away. So finding the things that give you, whether it’s art, music, what brings you joy, what sparks it for you, what makes you passionate, right? That is one of my big key interventions that is so important to me, because I think once we do that, then we can kind of tap into, “okay, these are the things that work for me, and these are the things that don’t.” Other people that I’ve seen, have seen music do that. And sometimes it’s just getting that one good friend and like having a dialogue. There’s so many different things, but in my therapy, in my space, I’m first working on that. Let’s find new adaptive coping skills. What brings you joy? What brings you happiness? And then as that sort of manifests itself and hopefully connects, then I’m working on, okay, what’s the underlying issue here? What really drove your eating disorder or drove your anxiety or how did it all kind of unravel and really sit back and explore and try to give that a name and give it some work, and usually that kind of leads towards that more recovery success. If you’re at home listening right now, tap into what brings you joy. Like what is going to make you happy right now? And it’s a big rhetorical question for a lot of people, especially adults, you know, people who tend to get married, have kids, they start to lose themselves in their identity, their work identity. We want to go outside of that. We want to really find you. And it could be something so small, but so big when you really look at it and replace that. So yeah, for long term recovery and stability, I definitely want to look at underlying and process trauma and do all that. In the here and now, I want to find you what works to reduce that anxiety in the moment and start getting you to use it. And then from there, we go down the longer path.

Sam: You know, I love this idea of, you know, reconnecting with the part of you. It’s like what brought joy to you as a child, which I think can be kind of scary to do as an adult because it’s like, well, isn’t that childish? So-

Francesca: Yeah, I mean, I had a lot of resistance.

Sam: And, but to really push through that discomfort and maybe try the things that maybe you always wanted to try as a kid or the things that did bring you joy as a kid.

Francesca: I had one client who was like, I always wanted to play tennis. I wanted to play tennis my whole life, but I live in New York City and like, where am I playing tennis? I’m like, we’re getting you to the suburbia and there’s places in the city too. But we’re getting to the suburbia and we’re getting your tennis racket and you’re just going to take a lesson or you’re just going to join a clinic. Or patients in the summer, like join a league. There just are so many things that are outside the box. And I think that’s where I really see so much growth, because people then become proud of themselves. Again, reconnecting to that self-confidence. Even if they’re not that star tennis player, they’re like, “wow, I did something that was unexpected of me.” And this also helps that interpersonal connection, which I think is really lacking right now in society, that ability to like go into a room in a clinic by yourself and make a friend, right? We are so impressed right now. A lot of work from home, a lot of separation, and a lot of online dating, which is all wonderful and amazing because it connects so many people, too, but that really in your face, can we do this and spark this conversation? Wow, I’m good at making a friend or doing something else is really encouraging.

Sam: Yeah, absolutely.

Ashley: Okay, Francesca, we are kind of coming down to the end. But before we get off, I know you kind of said something that I thought was amazing, just like finding your joy, finding the thing that makes you happy. But if you could leave our listeners with like one thought or like a big thought, what would that be like? What do you want them to take away?

Francesca: I would interconnect those two and say like, you’re not alone. Yeah, find your joy. Those are part of my big spaces. But I think also to recognize like you’re here, you’re listening. You want to learn, right? You want to grow. So to me, that is the hardest part, is to be able to say, I do want to, you know, reach out to that therapist, or reach out to that support group, or talk to a loved one about how I’ve been feeling. Like those moments are huge. When someone emails me for the first time in an inquiry, one of my first responses back is, great job. Like that was not easy. First of all, searching for a therapist and trying to find all of that, like, whole process. So you’re here, you’re listening, you made it to this point in the podcast, like amazing, kudos to you, you can do it. And if it means you’re not ready to open up to a loved one or open up to a therapist, open up to a notebook, you know, connect with yourself. Again, it goes back to all of this, like find yourself, find that inner person, love that inner person, you know, it’s so we can call it Hallmark-y as it sounds, you only got yourself really at the end of the day. It’s you and you have to feel that space. And if you don’t feel it right now, that’s OK. Not everyone feels it at every moment. We want to get glimpses, glimpses of joy, glimpses of good moments, glimpses of self-confidence to get you to that next space. You’re going to be OK. I think it’s so comforting for people to walk in or listen to something like this. I’m not alone and I’m going to be OK.

Sam: Yeah. Powerful. Thank you so much, Francesca. This was wonderful to connect with you, and our audience listening, thank you also for joining us. So many of us struggle with anxiety and navigating an eating disorder anxiety is even harder. So thanks for tuning in and hopefully this was helpful.

Ashley: Thank you for listening with us today on All Bodies. All Foods. presented by the Renfrew Center for Eating Disorders.

Sam: We’re looking forward to you joining us next time as we continue these conversations.

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