Session 3: Addressing Compulsive Exercise

CONTENT

​

1) Welcome, Review of Treatment Map, and Agenda-Setting

• Review goals/homework from previous sessions. 

• Topics today: (1) compulsive exercise + (2) addressing strict rules about exercising.

 

 

​

2) Review of Goals/Homework from Previous Sessions (approx. 20 mins)

• Review dieting behavioural experiment

 

Questions to ask client:

• How did you go with challenging a fear food/situation or a dietary rule? 

• What happened? 

• What did you learn?

• What will you challenge next?

 

• Attempting flexible eating

​​

Questions to ask client:

• How did you go with eating more flexibly over the past week? What changes did you make?

• What did you learn?  

• What will you change next?  

 

 

3) Healthy vs. Unhealthy Exercise (approx. 15 mins)

• Exercise is universally regarded as a positive for our health and wellbeing.

• However, for a lot of people with MD, exercise can become something that:

  (1) is stressful and guilt-driven + (2) leads to significant health consequences + (3) reduces time for other important life activities. 

 

Questions to ask client:

• What is the difference between healthy and unhealthy exercise?  

• When does exercise become unhealthy? 
   

• Possible answers:

  (1) it becomes addictive/compulsive (e.g., feel compelled to train because of guilt rather than wanting to train) + (2) it leads to injuries or significant health consequences + (3) you feel unable to take time off when feeling sick or injured + (4) it starts to impede on other important areas of life, such as seeing to friends or being able to concentrate at work + (5) training 7x days per week without a rest day.  

 

 

4) Compulsive Exercise (approx. 5 mins)

• ‘Compulsive exercise’ is the clinical term used in MD and EDs to describe a pattern of unhealthy exercise behaviour that maintains a disorder.

• Compulsive exercise is defined according to the qualitative dimensions of exercise, rather than its quantitative characteristics (e.g., hours spent working out, number of sessions per week, etc) – although it is common knowledge that at least one rest day is needed per week to promote muscle recovery and reduce the risk of injuries. 

   

  •       Dittmer et al. (2018) put forth the most comprehensive definition of compulsive exercise:
  
  
  
  
  
  
  
  
  
  ​
  
  
  
  
  
  
  Question to ask client:

• Does this definition resonate with you? Which parts?  

 

 

5) Exposure and Response Prevention
(approx. 20 mins)

• The goal of this program is not to reduce the amount of time you spend exercising – it is to help re-associate exercise as something that is done for positive reasons
(e.g., self-improvement + improve health + learn new skills + meet new people) rather than to avoid feelings of guilt + boredom + anxiety.

 

• Another goal is to help you develop the ability to rest temporarily when further exercise might be dangerous/harmful (e.g., when sick or injured).

• Sometimes our body is signalling that we need rest (e.g., if experiencing pain or injuries + feeling high levels of fatigue).

• When we ignore these short-term signals, we set ourselves up for long-term consequences.

 

• Introduce the rationale for exposure and response prevention - to be able to experience urges to exercise but be able to resist succumbing to those urges.

• We will alternate these exposure and response prevention tasks so that one is completed this week and one is completed next week (so the order does not matter).

 

Note to clinician: these below exposure tasks are guides. Feel free to modify these activities depending on the client’s level of compulsive exercise and readiness to change.

 

Exposure and response prevention behavioural experiment (option one)

• Drive to the gym or the place where you normally exercise.

• Complete a full warm-up as if you were preparing to perform a full workout.

• Leave the gym without completing any working sets.

• Monitor levels of anxiety before + during + after (both directly after and 10 minutes after).

 

Exposure and response prevention (option two)

• Pick a day where you would normally exercise.

• Schedule a rest day instead where you are not allowed to do any resistance training or scheduled cardio.

• This rest day must be in addition to other scheduled rest days – if you train 6 days a week normally, you will only train 5 days this week.

• Monitor anxiety + thought + feelings throughout the day.

 

6) Setting Goals/Homework

​

• Carry out another behavioural experiment to challenge fear foods/situations and/or dietary rules.

• Carry out exposure and response prevention task related to exercise.