Rewards and Consequences
Rewards: If you seriously want to stop a certain behavior, it might work to set up a reward system for yourself. The urge to engage in a behavior can become so strong and so automatic that a vague reward, wanting to get better, or a long-term reward, I want to be healthy enough to have children when I get married, are usually not strong enough to help you stop in the moment. Sometimes, however, short-term rewards can make a difference if the reward you come up with is compelling and immediate enough.
The following list contains some of the rewards clients have used:
1. If I eat my meal plan each day, I get to go to the gym
2. If I have a binge- and purge-free day, I can buy a new pair of shoes.
3. I can get a massage when I have a binge- and purge-free week.
4. If I try a food I’m afraid to eat, I can get my nails done.
We know that you might be thinking, If this worked, I could have gotten over my eating disorder long ago. We understand that often rewards like this will not work, but sometimes at the right stage of recovery, they can and do help. Some people find using (negative) consequences works better than rewards. Our experience is that people with eating disorders, particularly anorexia, are more highly motivated to avoid consequences than to get rewards. There is even some research to indicate this might have something to do with genetic predisposition.
Consequences: Even if you are seriously motivated to stop a behavior, the habitual nature of it along with the fact that there are no immediate consequences can make it hard to stop. You can probably come up with long-term consequences, but those do not have enough impact to affect you in the moment. The more immediate the consequence, the more likely it is to have an impact. You might know you gain weight if you binge, but you do not see weight being added immediately to your thighs. You might know that restriction of food leads to bone loss, but in the moment, you do not feel your bones losing density after skipping lunch. We ask clients who are ready to stop a behavior to come up with a meaningful consequence they will impose on themselves if they engage in it. We do not push this assignment on clients, or try this with people who are still very ambivalent. This assignment takes a strong desire to stop the behavior, and it helps if there is someone you trust to be accountable to. (You might be able to be accountable to yourself, but it is much harder, so think about who might be able to support you.)
One client shares her experience:
Even after years of treatment, I was still having trouble with my behaviors around food. Despite all the insight I’d gained, simply putting the food in my mouth was still a frequent struggle . and I didn’t even really know why. More than anything, it felt like a very very bad habit that I just couldn’t break.
When I went to Carolyn for help, she asked me to name something I really cared about. My answer: Kevin Garnett and the Minnesota Timberwolves. My dad and I grew up watching basketball together and it is a real passion for me.
Kevin is my hero and I saw all of his games.
Perfect, Carolyn said. If and when you restrict, you do not get to watch Kevin’s next game. I was simultaneously horrified and relieved, because I knew she really had me with that idea. I had this funny feeling that this could help me not restrict, and yet I felt a bit trapped now.
For this to work, I had to be willing to stick with the deal, and stay really honest with my therapist and myself. Of course there were much bigger reasons I wanted to recover than simply to watch basketball games, but making the consequence so tangible and immediate really worked for me. The next time I wanted to restrict, I realized I would have to share this and lose my ability to watch the game. I ate. It was hard but I did it.
Here are some examples of consequences that worked for our clients.
1. Washing my spouse’s car if I purge.
2. Giving $10 a minute to the Republicans if I exercise over one hour. (This from a hard-core Democrat with an exercise disorder.)
3. Paying $5 to my therapist every time I binge. She keeps it in a jar and will give it back to me when I have 2 weeks free of bingeing. After 3 months, if I have not done it, she gives it to a charity I do not support.
4. If I do not follow my meal plan I have to call my boyfriend, or friend and cancel our plans.
The above consequences are all real examples that helped clients stop entrenched behaviors. They worked because the client was ready and wanted to stop the behavior, but it had become so ingrained, something more immediate to motivate or deter was needed. This technique works best if you decide the terms. It is not as effective if someone threatens to do it to you.
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