Анонимные переедатели

«Анонимные переедатели» ( ОА ) — это программа из двенадцати шагов, основанная Розанной С. Его первая встреча состоялась в Голливуде, Калифорния, США , 19 января 1960 года, после того как Розанна посетила собрание Анонимных Игроков и поняла, что Двенадцать Шагов потенциально могут помочь ей справиться с ее собственным зависимым поведением, связанным с едой. С тех пор ОД разросся: группы в более чем 75 странах встречаются лично, по телефону и через Интернет. ОА предназначен для людей с проблемами, связанными с питанием, включая, помимо прочего, компульсивное переедание , людей с компульсивным перееданием , булимиков и анорексиков . Приветствуются все, у кого проблемные отношения с едой; Третья Традиция ОА гласит, что единственным требованием для членства является желание прекратить компульсивное питание.

Штаб-квартира ОА, или Всемирный офис обслуживания, находится в Рио-Ранчо, штат Нью-Мексико . По оценкам организации «Анонимные переедатели», ее членами являются более 60 000 человек в примерно 6 500 группах, встречающихся в более чем 75 странах. ОА разработало свою собственную литературу специально для тех, кто питается компульсивно, но также использует Анонимных книги Алкоголиков. и «Двенадцать шагов и двенадцать традиций» . Первый Шаг ОА начинается с признания бессилия перед едой; следующие одиннадцать шагов призваны принести членам «физическое, эмоциональное и духовное исцеление».

Определения

ОА определяет компульсии как «любой импульс или чувство непреодолимого влечения к совершению какого-либо иррационального действия». ОА далее определяет компульсивное переедание как прогрессирующее заболевание, вызывающее привыкание. ОА рассматривает компульсивное переедание как хроническое состояние и часть попытки облегчить психологический стресс.

Как и другие программы из двенадцати шагов , ОА рассматривает компульсивное переедание как тройную болезнь, символически понимая человеческую структуру как имеющую три измерения: физическое, психическое и духовное. Компульсивное переедание проявляется в каждом измерении. В книге, описывающей себя как основанную на методах открытого доступа, говорится, что в ментальном измерении компульсивный едок не «поедает» чувства, а скорее выражает «внутренний голод».

Чтобы помочь потенциальным участникам решить, нужна ли им программа или нет, OA предлагает анкету, в которой задаются такие вопросы, как: «Уделяете ли вы слишком много времени и мыслей еде?» Ответ «да» на три или более из этих вопросов считается хорошим показателем проблем, с которыми OA может помочь.

Воздержание при ОА

«Воздержание в Анонимных Переедающих – это действие по воздержанию от компульсивного питания и компульсивного пищевого поведения при одновременном стремлении или поддержании здорового веса тела». Эту концепцию воздержания критиковали за отсутствие конкретики. Хотя в АА воздержание означает отказ от употребления алкоголя, некоторые утверждают, что невозможно указать конкретные продукты, поскольку опыт ОА показывает, что у разных людей разные пищевые триггеры (т.е. продукты и пищевое поведение, которые заставляют их есть компульсивно). Хотя часто говорят, что алкоголикам не обязательно пить, но компульсивным обжорам все равно приходится есть, Анонимные переедающие в ответ отмечают, что алкоголикам приходится пить, но они не могут пить алкоголь, точно так же, как компульсивные обжиратели вынуждены есть, но нельзя есть продукты, вызывающие компульсивное переедание.

В литературе ОД конкретно определяется «принуждение» следующим образом: «По определению, «принуждение» означает «импульс или чувство непреодолимого влечения к совершению какого-то иррационального действия». Таким образом, «компульсивное питание» и «компульсивное пищевое поведение» (как эти термины используются в определении воздержания, предложенном ОА) означают иррациональное питание или иррациональное пищевое поведение, воспринимаемое как результат импульса или чувства, которое кажется непреодолимым. Итак, по мнению Анонимных Переедающих, «воздержание» — это воздержание от «компульсивного переедания» и «компульсивного пищевого поведения» при одновременном стремлении к поддержанию здорового веса тела или его поддержании. Хотя это определение справедливо можно охарактеризовать как детальное и допускающее индивидуальную интерпретацию (например, определение «здоровой массы тела») или требующее самостоятельного анализа (например, для определения движущих сил определенного поведения), оно не является неспецифичным. .

Цель определения воздержания, данного ОА, заключается в том, что компульсивный едок воздерживается не от еды, а, скорее, от компульсивного питания и компульсивного пищевого поведения, и стремится к достижению или поддержанию здорового веса тела. Таким образом, ОА призывает человека, склонного к компульсивному еде, определить свой собственный план питания, который позволит ему воздерживаться от компульсивного питания и компульсивного пищевого поведения, одновременно стремясь к поддержанию здорового веса тела или поддерживая его.

Программа предлагает участникам определить продукты, которые «провоцируют» переедание. Поскольку люди несут ответственность за определение своего собственного плана питания, они могут изменить свой план питания, если их потребности и понимание своих пристрастий меняются, причем это изменение не является нарушением воздержания. Членам рекомендуется проконсультироваться с другими людьми, прежде чем вносить такие изменения, обычно включая члена или членов стипендии открытого доступа, чтобы убедиться, что причины веские, а не являются непреднамеренным решением, основанным на принуждении.

Инструменты и стратегии восстановления

Группа анонимных переедающих в Сантьяго-де-Компостела ( Испания )

Программа ОД основана на двенадцати шагах и двенадцати традициях Анонимных Алкоголиков. Были внесены небольшие изменения, чтобы сделать их применимыми к расстройствам пищевого поведения, но такая адаптация была минимальной. Чтобы выполнить двенадцать шагов и практиковать двенадцать традиций, литература по программам ОА рекомендует использовать девять «Инструментов выздоровления». Это План питания, Спонсорство, Встречи, Телефон, Письмо, Литература, План действий, Анонимность и Сервис. Эти инструменты считаются критически важными для достижения и поддержания воздержания.

Встречи предлагают согласованное подтверждение и помогают уменьшить чувство вины и стыда . Спонсор обеспечивает руководство в рамках программы открытого доступа и поддержку, где это необходимо, но постепенно поощряет самостоятельность спонсора. Спонсор стремится сделать свою работу устаревшей.

Food plans

In Overeaters Anonymous, abstinence is "the action of refraining from compulsive eating while working towards or maintaining a healthy body weight." According to OA, "by definition, 'compulsion' means 'an impulse or feeling of being irresistibly driven toward the performance of some irrational action.'" OA has a long and complex history with "food plans" and does not endorse or recommend any specific plan of eating, nor does it exclude the personal use of one. OA recommends that each member consult a qualified health care professional, such as a physician or dietitian. OA publishes a pamphlet, Dignity of Choice, which assists in the design of an individual food plan and also provides six sample plans of eating (reviewed and approved by a licensed dietitian) with which some OA members have had success.

Individual OA meetings and sponsors may make more detailed suggestions. Some of these caution against foods containing excessive sugar, caffeine and white flour. A qualitative analysis of bulimics recovering in OA found bulimic OA members with excessively rigid plans are less likely to remain abstinent. The researchers conducting the analysis suggested that new members begin with a somewhat rigid plan which becomes increasingly flexible by the end of a year in the program.

An individual's plan of eating may call for the exclusion of certain triggering behaviors. For example, a person who knows that eating after a certain time in the evening triggers compulsive food behavior might include in their plan of eating a commitment to abstain from eating after that time of night; a person who knows that snacking between meals triggers compulsive food behavior would probably include in their plan of eating a commitment to abstain from chewing (or sucking) between meals.

Demographics

In 2002 a dissertation compared the results of a survey of 231 OA members in the Washington, DC area of North America undertaken in 2001 with the findings from surveys of OA members taken in 1981, twenty years previously. The 2001 survey showed that 84% of OA members identified as binge eaters, 15% as bulimic, and 1% as anorexic. The 1981 survey had found that 44.5% of OA members identified as binge eaters, 40.7% as bulimic, and 14.8% as anorexic. The survey also found an increase in the percentage of males in OA from 9% in 1981 to 16% in 2001. Both figures are generally in line with estimates made by the American Psychological Association that the male to female ratio of those with eating disorders ranges from 1:6 to 1:10. The researcher stated that the typical OA member in Washington was white and highly educated. The typical OA member surveyed in 2001 worked in a full-time capacity and homemakers only comprised 6% of the 2001 OA population, in contrast to 30% of those surveyed in 1981. This reflects the trend for increasing numbers of females to be employed outside of the home. Further, 80% of the 2001 participants had attained a college degree, compared to 59% of those surveyed in 1981. The percentage of OA members who were divorced or separated had risen from 10% in 1981 to 21% in 2001, also reflecting trends amongst the general population.

Correlations with maintaining abstinence

Research has identified a number of OA practices significantly correlating with maintaining abstinence in OA: adherence to a food plan (including weighing and measuring food), communication with other members (specifically sponsors), spending time in prayer and meditation, performing service work, completing the fourth step, completing the ninth step, writing down thoughts and feelings, attending meetings, reading OA/AA literature, and the educational status of the participant. Researchers have therefore concluded that application of OA practices might directly help promote abstinence and reduce the frequency of relapse in those with binge eating disorder and bulimia nervosa.

Honesty

Though not found in research to be significant, a number of OA members responded that honesty was a very important OA practice. Researchers have noted the high level of honesty at OA meetings and pointed out that working the Twelve Steps reinforces this quality.

Spirituality

Some researchers have found that in spite of its perceived high importance to the program spirituality does not correlate with measures of weight loss; others have found somewhat contradictory conclusions. In particular, an increased sense of spirituality was correlated with improvement in eating attitudes, fewer body shape concerns, and better psychological and social functioning. However, measures of religiosity and particular religious affiliations have never been found to correlate with treatment outcomes.

Demographic abstinence differences

Some research has found the average length of abstinence for bulimics in OA was significantly higher than the average length for binge eaters. Paradoxically, bulimics were also found to attend fewer meetings and had less of a commitment to write their thoughts and feelings down daily. However, the frequency of relapse for bulimics and binge eaters was not significantly different. The differences may be explained by the predictable nature of the bulimic cycle. Other research has found binge eaters in OA had better success than bulimics. Most OA members who have reported negative experiences in the program are anorexic. This could be caused by OA's focus on problems of eating too much rather than too little. Some OA practices, such as refraining from eating certain kinds of foods, are antithetical in the case of anorexics.

Results

The average weight loss of participants in OA has been found to be 21.8 pounds (9.9 kg). Survey results show that 90 percent of OA has responded that they have improved "somewhat, much, or very much" in their emotional, spiritual, career and social lives. OA's emphasis on group commitment and psychological and spiritual development provided a framework for developing positive, adaptive and self-nurturing treatment opportunities.

Changes in worldview

Changes in worldview are considered critical for individuals in the recovery process, as they are generally accompanied by significant behavioral changes. Accordingly, several researchers have identified worldview transformation in members of various self-help groups dealing with addiction issues. Such research describes "worldview" as four domains: experience of self, universal order (God), relationships with others and perception of the problem. In OA, members changed their beliefs that "it is bad to eat" to "one must eat to stay alive and should not feel guilty about it"; "one is simply overweight and needs to lose pounds" to "one has underlying psychological and interpersonal problems"; "one must deprecate oneself, deprive oneself, please other people" to "it is okay to express positive feelings about oneself and take care of one's needs"; "food is the answer to all problems, the source of solace" to "psychological and emotional needs should be fulfilled in relationships with people"; "I am a person who eats uncontrollably" to "I am someone who has limitations and does not eat what is harmful for me."

Understanding of control

The act of binging and purging provides bulimics with the illusion that they can regain a sense of control. Binge eating has been described as a "futile attempt to restock depleted emotional stores, when attempts at doing everything perfectly have failed." The self-destructive behavior of injecting intoxicating drugs parallels overeating; it permits the user to experience comfort, and to feel punished afterwards.

In relationships, many OA members attested to trying to control their own lives and those of others. Paradoxically, an OA member's experience of themselves was also characterized by strong feelings of personal failure, dependence, despair, stress, nervousness, low self-esteem, powerlessness, lack of control, self-pity, frustration and loneliness. As part of these feelings, the self was perceived as being both a victim of circumstances and a victim of the attitude of others. Many members viewed this lack of self-esteem as deriving from their external appearance. Harsh self-criticism is a typical characteristic, accompanied by feelings of "I don't deserve it" and "I'm worth less than others." Such feelings were found to have a dominant influence on relationships with others.

Members describe their sense of relaxation and liberation, and the increasing value of restraint and modesty in their lives. Their testimonies show that, paradoxically, it is by becoming aware of their powerlessness and accepting the self's basic limitations that they begin to feel the recovering self's growing power. At the same time, personal responsibility replaces self-pity and the expectation that others will act for the good of the individual. With these old attitudes, egocentricity and exaggerated, false self-confidence perpetuate the problem which led them to join OA. While their eating disorder was active, many OA members claimed that their experience of self was composed of an obsessive aspiration for perfection which concealed their sense of worthlessness.

Comparisons

A significant difference between Twelve Step work and cognitive-behavioral therapy is the acceptance of a Higher Power and providing peer support. A large study, known as Project Match, compared the two approaches as well as motivational enhancement therapy in treating alcoholics. The Twelve Step programs were found to be more effective in promoting abstinence. However, some researchers have found that cognitive-behavioral therapy is the most effective treatment for bulimics. The two approaches are not mutually exclusive.

OA is most appropriate for patients who need intensive emotional support in losing weight. Each OA group has its own character and prospective members should be encouraged to sample several groups.

Criticism

OA differs from group therapy in not allowing its participants to express their feelings about (and to) each other during meetings. OA meetings are intended to provide a forum for the expression of experience, strength and hope in an environment of safety and simplicity.

Feminist criticism

OA has been an object of feminist criticism for encouraging bulimic and binge-eating women to accept powerlessness over food. Feminists assert that the perception of powerlessness adversely affects women's struggle for empowerment; teaching people they are powerless encourages passivity and prevents binge eaters and bulimics from developing coping skills. These effects would be most devastating for women who have experienced oppression, distress and self-hatred. Twelve-step programs are described as predominantly male organizations that force female members to accept self-abasement, powerlessness and external focus, and reject responsibility. Surrender is described as women passively submitting their lives to male doctors, teachers and ministers; the feminist view suggests that women focus on pride instead of humility.

OA contends that the context of powerlessness within the program isn't referring to an individual's flaws, but simply with the acceptance that they have a problem with food that they cannot seem to defeat with their unaided will. The slogan "We are powerless, not helpless," is an example of this distinction. By accepting that they are powerless over certain things and thereby surrendering the illusion of control, they are then able to make an honest appraisal and make clearer decisions about what they truly do control.

Possible fanaticism

Opponents of Twelve Step programs argue that members become cult-like in their adherence to the program, which can have a destructive influence, isolating those in the programs. Moreover, this kind of fanaticism may lead to perception that other treatment modalities are unnecessary. Surveys of OA members have found that they exercise regularly, attend religious services, engage in individual psychotherapy and are being prescribed antidepressants. This is evidence that participants do not avoid other useful therapeutic interventions outside of Twelve Step programs.

Literature

OA also publishes the book Overeaters Anonymous (referred to as the "Brown Book"), The Twelve Steps and Twelve Traditions of Overeaters Anonymous, For Today (a book of daily meditations), the OA Journal for Recovery, a monthly periodical known as Lifeline, and several other books. The following list is not comprehensive.

• Overeaters Anonymous (January 2001). Overeaters Anonymous. Torrance, California: Overeaters Anonymous, Incorporated. ISBN 1-889681-02-4. OCLC 47722165.
• Overeaters Anonymous (October 1993). The Twelve Steps and Twelve Traditions of Overeaters Anonymous. Torrance, California: Overeaters Anonymous. ISBN 0-9609898-6-2. OCLC 30004811.
• Overeaters Anonymous (1995). Journal to Recovery (Overeaters Anonymous). Overeaters Anonymous, Incorporated. ISBN 0-9609898-8-9.
• Overeaters Anonymous (October 1994). Abstinence: Members of Overeaters Anonymous Share Their Experience, Strength, and Hope. Rio Rancho, New Mexico: Overeaters Anonymous. ISBN 0-9609898-7-0. OCLC 32666911.
• Overeaters Anonymous (April 1993). The Twelve-Step Workbook of Overeaters Anonymous. Torrance, California: Overeaters Anonymous. ISBN 0-9609898-5-4. OCLC 30170467.
• Overeaters Anonymous (October 1990). Twelve Steps of Overeaters Anonymous. Torrance, California: Overeaters Anonymous. ISBN 0-9609898-3-8. OCLC 22811051.
• Overeaters Anonymous (1998). A New Beginning: Stories of Recovery from Relapse. Rio Rancho, New Mexico: Overeaters Anonymous. ISBN 1-889681-01-6. OCLC 40664593.

See also

• List of twelve-step groups
• TOPS Club, Inc.
• Food Addicts in Recovery Anonymous
• Food Addicts Anonymous

Further reading

• Джонсон, К.Л., и Тейлор, К. (декабрь 1996 г.). «Работа с трудноизлечимыми расстройствами пищевого поведения с использованием интеграции двенадцати шагов и традиционной психотерапии». Психиатрические клиники Северной Америки . 19 (4): 829–41. дои : 10.1016/S0193-953X(05)70384-1 . ПМИД   8933611 . {{cite journal}}: CS1 maint: несколько имен: список авторов ( ссылка )
• Гольдберг, Лина «История анонимных переедающих и их план питания» [1]

Внешние ссылки

• Анонимные переедатели