ClinicNotes: September 2025
welcome to ClinicNotes - a newsletter designed for practitioners working with relationship with food & eating behaviour. This is my public journal, where I share the latest research, tools, training, and anything else useful to practitioners working with eating difficulties and behaviour change.
ending well and planning for relapse prevention
One of my clients (late 20s, history of restriction and binge eating) is approaching the end of her recovery programme. Endings can feel daunting (for both practitioners and clients), but they’re an important part of recovery.
Here’s how we approached it:
Personalised view of recovery: Early on in the recovery programme, we identified her specific definition of recovery. We used various approaches to achieve this, including a “5 years’ time” letter where she had articulated what her life would look like without disordered eating.
Indicators of progress: We reflected on what has changed since her first session. She is less preoccupied with food and her body weight, has widened her life beyond food rules and uses adaptive coping strategies rather than relying on eating disorder behaviours.
Relapse prevention plan: Together, we created a written plan covering:
Helpful behaviours (aiming for balanced meals (80% of the time), journaling, grounding).
Trusted people she can reach out to when things feel challenging.
High-risk triggers (e.g., when she is stressed at work, comments about her body/weight).
Personal warning signs (e.g., skipping meals, urges to overexercise, calorie counting).
Tiered coping strategies – from “light touch” (taking a walk) to more “involved” (contacting a support group).
A toolkit of useful resources including her “5 years’ time” letter, visualisation exercises, journal reflections, for her to revisit when life feels hard.
🧭 Key insight: Relapse prevention planning is an essential part of the recovery journey. It helps frame recovery as an ongoing journey rather than an end destination and gives clients the confidence, tools and support structures to sustain progress long-term. You can find a useful template here.
👉 We cover evaluation, endings, and relapse planning in depth in Nutritional Therapy for Eating Disorders: Advanced Practitioner Programme. [Join the waitlist here].
understanding behavioural patterns
(using ABC)
Understanding behavioural chains and patterns helps clients to zoom out and see the function of their eating behaviours. They shift the focus from “what did I eat?” to “what was happening around me, how did I respond, and what might be the consequences of this?”
There are lots of frameworks you can use clinically to build clients’ awareness of behaviour patterns. One I like is the ABC framework from CBT:
A – Antecedent (Triggering Event)
What happened beforehand? This could be an external event (a comment about weight, seeing food in the kitchen) or an internal one (feeling lonely, noticing body dissatisfaction).B – Behaviour
What did they do and how did they respond? This could be binge eating, restricting, body checking, overexercising, or even less obvious patterns like delaying meals or viewing diet content on social media.C – Consequence
What happened, both short and long-term?Short-term: distraction, numbing, temporary relief from anxiety.
Long-term: disconnection from values, negative impact on relationships, lower self-esteem, low energy.
🧭 Why this works: The ABC approach helps clients see the pay-off of a behaviour (e.g., immediate relief) alongside the longer-term costs. This opens a non-judgemental conversation: “What else could you try at point B that moves you closer to your values?”
Example:
A: Received critical feedback at work → felt anxious and inadequate.
B: Skipped dinner, then binged late at night.
C: Short-term relief from anxiety, but long-term exhaustion and disconnection from partner.
👉 By mapping this out, the client can see that the binge wasn’t “random” or “lack of willpower.” Instead, they can see it was a response to internal distress. Spotting these patterns can help clients to be curious about their behaviours and is the first step to helping them intervene and change them.
👉 We go much deeper into psychological tools like this in Nutritional Therapy for Eating Disorders: Advance Practitioner Programme, giving you the confidence to use them safely and effectively in practice. [Join the NTED waitlist here].
the jigsaw puzzle
Recovery is like piecing together a jigsaw puzzle. Clients often want the “big picture” straight away, but early pieces can feel random and disconnected. Over time, as more pieces click into place (values work, defusion skills, nutrition, social support), the image becomes clearer.
And just like with a puzzle, sometimes clients try to fit a piece in the wrong place. That’s not failure, it’s information.
👉 what do you make of this metaphor? Pop me a message on Insta and let me know!
ADHD and eating disorders online workshop
25th September 2025
Join Consultant Psychiatrist Dr. John Roche and other experts for an interactive workshop exploring the intersection of ADHD (Attention Deficit Hyperactivity Disorder) and eating disorders.
This session will delve into:
Understanding ADHD and its overlap with eating disorders such as anorexia, bulimia, binge eating disorder, and ARFID.
Management strategies for ADHD in patients with co-occurring eating disorders.
Interactive presentations and discussions informed by clinical expertise and lived experience.
Designed for clinical professionals, academics, carers, and family members, the workshop aims to provide valuable insights into these complex conditions.
This review explored how social media (especially appearance-focused content) affects body image and eating disorder risk. Evidence suggests it can increase self-objectification, body shame, and disordered eating behaviours.
A recent model proposes that while social media may heighten body focus and negative feelings, self-compassion acts as a protective buffer. Early research supports this link, but more studies are needed to confirm the model and guide strategies that build a more productive body image.
This study explored how parenting styles link to eating concerns through the lens of attachment theory. Findings showed that paternal overprotection, maternal rejection, and maternal overprotection were associated with lower self-compassion, which in turn predicted greater eating concerns. Conversely, maternal emotional warmth was linked to higher self-compassion and fewer concerns.
Self-compassion fully mediated these relationships, suggesting it’s a key mechanism. Clinically, this highlights the potential of interventions that build self-compassion and, where relevant, address parenting dynamics.
This study tested whether focusing on body functionality offers unique benefits for women’s body image compared to focusing on appearance or personality. In an online experiment with 260 women, participants completed a 10-minute writing task that encouraged appreciation of either body functionality, appearance, or personality.
Results showed that functionality-focused writing reduced self-objectification, increased body appreciation and functionality satisfaction, and boosted gratitude compared to the other conditions. These findings highlight the value of simple, brief interventions that foster functionality appreciation as a promising approach to improving body image and wellbeing.
💡 Practitioner Tip: Invite clients with body image concerns to spend 10 minutes writing about what their body does for them (e.g., moving, hugging, dancing, breathing), rather than how it looks. This can be a powerful reframe that shifts focus from appearance to function.
✨ Final Word
Each month, I share tools and insights here but if you want to move beyond tips and into comprehensive, credited training that prepares you for the complex realities of ED practice, that’s what Nutritional Therapy for Eating Disorders: Advanced Practitioner Programme is designed for [Join the NTED waitlist here].
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