Scott Webb (Host): When it comes to eating recovery,
Sierra Tucson may not be top of mind for folks. But thanks to the expertise of
recovery dieticians and Sierra Tucson's Secondary Eating Recovery Services, it
might be the perfect place to receive the treatment that you need. And joining
me today are Larisa Larisa Biznichuk, she's the Director of Secondary Eating
Recovery Services at Sierra Tucson. And I'm also joined by Jessica Griffith,
she's an eating recovery dietician with Sierra Tucson.

Host: This is Let's Talk: Mind, Body, Spirit by
Sierra Tucson. Sierra Tucson, a leader in the field of behavioral healthcare
since 1983. I'm Scott Webb.

So, it's great to have you both on today we're going to talk
about eating recovery and what that means in practical terms and how you help patients,
clients, and so on. Before we get to that though, let's start here, Jessica.
Tell us a little bit about yourself, how you got into the field and what you
do.

Jessica Griffith: Well, hi. Thanks for having us. I'm
Jessica Griffith. I am a registered dietician and a certified eating disorder
specialist at Sierra Tucson. Before I began my career in eating disorders, I
actually worked in sports at nutrition, predominantly working with college and
professional athletes, the collegiate setting and human performance. Over time,
I found the higher the competition, the more eating disorder risk and red flags
are associated with that level of competition. Eating disorders are a specific
niche and a skillset I wasn't strong at during that time in my field. So, I
decided to take a step back from sports and learn more about eating disorders.
The only way to really learn is to immerse yourself into the field in and of
itself. I saw the benefit of educating myself how to assess and treat eating
disorders since it does go hand in hand in the field of sports nutrition and
come to find out I really enjoyed this field as well.

Scott Webb (Host): Yeah. I mentioned, we were talking
about cold weather softball where I live, and my daughter's an athlete,
softball, basketball, wants to play in college, so maybe we can do a separate
podcast about that. But for today, Larisa, I want to give you an opportunity as
well. We joked a little bit, you have lots of letters after your name. What do
all those letters mean? Tell us little bit about yourself, what you do and what
all those letters mean.

Larisa Biznichuk: My name is Larisa Biznichuk. I'm a
psychiatric nurse practitioner, and B and C means board certified. I worked for
Sierra Tucson for almost eight years now. And before that, I did have
experience working with mental health, psychiatric mental health, in a
community clinic. So with that, when I came to Sierra Tucson, that was very
interesting times, a lot of changes were going on. And I decided that I am very
much interested in eating disorders and I had an opportunity to jump into this
field. And like Jessica said, you have to immerse yourself to learn about
things. So, I immersed myself into eating disorders, working with clients with
eating disorders and mental health, and I'm enjoying this field very much so.

Host: That's nice. I'm enjoying your accent as well.
I love accents, so my mind starts to drift a little bit when I hear someone
with an awesome accent. So, it's great to have you both on. Jessica, I know
you're an RD, a registered dietician. So, tell listeners what that means and
what you do sort of in practical terms at Tucson.

Jessica Griffith: Absolutely. So, a registered
dietician is a credentialed and board-certified medical nutrition professional.
Just like a medical doctor, we as dieticians have a distinct pathway that
requires formal education, training and passing a national board exam to earn
the credential licensure and the title of registered dietician, which can be
really confusing to residents or anyone really.

In summary, all dieticians are nutritionists, but not all
nutritionists are dieticians. When it comes to the term nutritionist, there are
absolutely no requirements for someone to call themselves a nutritionist or
things like a nutrition coach or a health coach. They might have some education
experience, but many do not have the formal education and training.

Host: I see what you mean. I was just thinking about,
you know, you were talking about what you did before in your sort of previous
life and I was just thinking about my daughter and I were at a basketball
tournament and what we subsisted on while we were there, Crumbl Cookies, things
like that. And I know that I--

Jessica Griffith: All foods fit.

Host: Yeah. Yeah. And I'm just like, you know, we
also had some bananas in the room, so bananas and granola and some cookies. So
yeah, diet is so important, right? And eating right and getting that right and
seeking professional help when we need it. So, Larisa, let's bring you back in
here. What can residents expect when they meet you?

Larisa Biznichuk: When clients are first admitted to
Sierra Tucson, they're coming to our inpatient unit where they're first
evaluated. Some of them need detox, other needs the monitoring of their safety,
some of the clients needs to be assessed for an eating disorder. It depends on
their acuity. In most cases, our dietician will consult a client, determine if
client is appropriate for our program and if they're in need of followup. When
the clients who are accepted into our eating recovery truck are transferred to
Sierra Tucson residential setting, they're usually assigned to me.

On our first meeting, I evaluate clients for severity of
trauma or mood or addiction or eating disorder or all of the above. We also
discuss some of the pharmacological management of their symptoms, laboratory
results and genetic testing if we have it available. We will discuss some
correlation between symptoms and behaviors which they exhibit, you know, if
trauma related to eating disorder or eating disorder related to trauma, and we
definitely will discuss the course of treatment. Basically in short, they can
expect from me the assessment, education and pharmacological treatment.

Host: Yeah, it's good to understand the process, I'm
sure for listeners especially. You two, when you came on, you were talking to
each other and laughing with each other. I'm assuming though, you don't do the
exact same thing, that you guys work together, at least you know each other.
Maybe you can address that a little bit, Jessica. Like, how do you and Larisa
work together?

Jessica Griffith: That's complex in nature.

Host: I love that.

Jessica Griffith: So, sometimes a patient will meet
with me before they see Larisa. It just all depends on a patient's history.
Typically, they'll see a dietician first. There's more than just myself. I have
two other colleagues, hoping for a fourth.

Host: Sure. Nudge, nudge, Sierra Tucson.

Jessica Griffith: They could use the support. I think
it's pretty standard, and when I say standard, what residents might expect from
their psychiatric provider. However, when they work with a dietician, I think
they just think we're going to talk about food groups. And that's like the
least of the amount of work that I do with them. So, I typically meet with them
for an hour and I go over both their medical and behavioral nutrition history.

So, medical nutrition history is pretty straightforward,
like their diet intake, labs, weight trend, any medications associated with
nutrition. But most of it is behavioral nutrition, which catches residents off
guard. And I always explain to them like, if you're coming to Sierra Tucson for
mood, trauma, pain, or addiction, that's probably impacting your appetite and
intake, whether you're not eating all the things, or swinging back and forth,
getting rid of our food. And so with that assessment, I will determine if
they're clinically appropriate for our secondary eating recovery program. And
we emphasize secondary because we are not a primary eating disorder treatment.
We're primary mood, trauma, pain, addiction. So, we are supporting a resident
through their journey. And that's how I'm like, "Hey, I would really
appreciate if this resident could be assigned with Larisa as she is the
provider for the eating recovery team, she's the director." So, our main
work is, you know, beyond just the patients, it's treatment team meetings. I
mean, it's this podcast.

Host: Absolutely.

Jessica Griffith: We do a lot of things to not only
promote patient safety, but eating recovery support for Sierra Tucson and I
think Acadia overall because we are the crown jewel.

Larisa Biznichuk: For sure.

Host: I'm with you. I would not argue that. And
hopefully, a little nudge to Sierra Tucson, we could use a fourth person.

Jessica Griffith: Hint, hint.

Host: Absolutely. So Jessica, what are some of the
strategies then in nutrition therapy? Like what does that mean, nutrition
therapy? And what are some of the strategies?

Jessica Griffith: So as a dietician that specializes
in mental health, specifically eating disorders, I actually spend most of my
time conducting nutrition therapy. So again, little actually about food because
when it comes to disordered eating and eating disorders, it has little to do
with food, just how people can conceptualize drinking or any sort of substance
abuse or maybe gambling, risky behaviors as a way to like cope with their
feelings, so can food restriction or overeating, those can also be coping tools
as well.

So as a nutrition therapist, I utilize the same well-known
therapy modality such as CBT, DBT, ACT, just like our primary therapist, except
everything I focus on is related to food, body image, body functionality and
movement. My main role is to free a patient's primary therapist from discussing
topics related to their eating disorder, disordered eating, so they can focus
on their primary reason for being at Sierra Tucson, which again might be mood,
trauma, pain or addiction.

Host: Yeah, it's really interesting and maybe,
Larisa, you can build on that a little bit. As I'm just thinking about people
and their relationships with food and the work that you both do and everybody
does there at Sierra Tucson to help folks, where do you kind of fit into this?

Larisa Biznichuk: I do try to build on whatever
Jessica is or any of our other dietician doing with the clients, trying to help
them to understand the importance of nourishing their brain in whatever, you
know, work they are doing, the trauma work, addiction work, mood disorder work.
We just need to make sure that, you know, their brain is nourished so it can do
the work. And I do a little bit of a joke with my client saying that I have a
very beautiful view from my office. I see the parking lot, but there is a lot
of trees there too, and Jessica can vouch for that.

Jessica Griffith: Well, at least you have a window,
so...

Larisa Biznichuk: Well, yes. Yeah, I do. And I love
it. So, what I usually tell my clients, "Look outside. What do you see
outside? You see a lot of cars, right? We won't be able to get to work. We
won't be able to get from work if we wouldn't put any fuel in the car. Why do
you think you will be able to do all this very hard work without fueling your
brain, your body?" And, you know, I think it sells people to understand
that, yeah, they need to make it more comfortable for them so they can do all
this work.

Host: Yeah.

Jessica Griffith: Strong motivational interviewing
skills are key when assessing a resident's relationship with not only food, but
their body image and with exercise. So, definitely using a lot of analogies.
There isn't a traditional questionnaire or sequence of questions to necessarily
come to a direct conclusion. In a roundabout way, we ask the same question in
multiple different ways in order for the patient to start unfolding their
nutrition history, starting from childhood to current day. And throughout the
assessment, they'll basically unfold their story. And as a clinician, we'll be
able to have a better idea and insight with their relationship with food and
behaviors.

Larisa Biznichuk: Yeah. And you know, that's for sure
if I can step in. That's for sure. We need to develop trust with our clients
and sometimes it takes time to develop trust and not all of the questions we
can ask right away. Now, there is definitely no template for the questions.

Host: Yeah. And of course, it's all, you know,
focused on the specific client and their needs and not one size fits all. And
one of the things I've learned in speaking with others from Sierra Tucson is
just the importance of, you know, clients being their sort of most real and
authentic selves. Leaving the masks, if you will, at the door and really being
honest. And I think Larisa, as you're saying, trust is so important to really
get the information you need to make proper diagnoses and really help people,
right?

Larisa Biznichuk: For sure. Yes.

Host: And I'm sure also that you see things like over
exercising or being overly focused on the "allowed foods," right? So,
how do you help clients stay in that middle ground, you know, to keep them
exercising because it's important to their overall health, like food and other
things, but not go too far and keep them away from what become obsessive
behaviors.

Larisa Biznichuk: Oh, I love this question. This is
absolutely, you know... Thank you.

Host: You're welcome.

Jessica Griffith: I think Sierra Tucson's curious of
how we do this in general.

Larisa Biznichuk: That's for sure. You know, and we
quite often hear this question. You know, we see it. We quite often have to
direct our clients to what's healthy and what's not healthy. And it kind of
ties in with our media. You know, people now have very easy access to social
media, where a lot of fitness and clean healthy eating advice intermixed with
the body shaming and sometimes very abusive content and content of the
information they receive. It's hard to avoid it. It's hard to not to hear that.
So, we're trying to find a happy media with our clients. And developing trust
between clinician and the client is the most important thing. You know, having
our client to understand that the clinician is actually on their side and trying
to help them. Not trying to, you know, get into the power struggle, you can do
or you cannot do things, but trying to help them to be healthy for themselves.
Yeah, it's hard. You know, we're all very different. We all have different body
types. We have different body image for ourselves.

Host: Yeah. As you say, the social media, every time
I open Instagram, you know, I'm left wondering, is there anyone on here who
isn't filtered? You know, who hasn't made themselves thinner and prettier and
all of that, you know?

Jessica Griffith: Oh, my goodness. Absolutely. It's
unfortunately normalized, you know, going on a diet or changing your body. So,
I mean, with that being said, sometimes it's just hard to find that middle
ground because our patients just need to be able to hear and see in the first
place that there's room for improvement with their relationship with food and
body image or just like they have an active eating disorder to begin with. When
everyone else is praising them for how they're achieving their ideal body and
not knowing that they're engaging in really harmful behaviors with food, it's
really hard for them to hear and see what us as clinicians that specialize in
this work have to say, and that our overall intent is to promote safety.

And that's where I try to help them find the middle ground.
I'm like, "This is what your intent is, but our actions are not aligning
with our intent. I'm not quite sure how restricting your food intake and being
obsessive about calories and reaching 15,000 steps, you know, just some
behaviors that are normalized that are praised from diet culture and social
media, how that's helping you be a better mom or helping you be a better
athlete, or how is that defining your health." So, it's a very complex
situation.

Host: It is. And it's hard to tackle all this in 20,
25 minutes in a podcast, but at least we get the conversation rolling and we
have a better sense of how you can help folks there. And wondering, Larisa, we
think about these negative thoughts and actions, how do you redirect that,
right? How do you channel that maybe is another way to put it. But when it
comes to eating recovery, how do you help folks with the negative thoughts?

Larisa Biznichuk: In my experience, the ability to
redirect client's negative self talk is directly connected to the level of
client's trust with the provider and to the ability of mitigate patient's
triggers. Redirecting negative self-talk related to eating disorder usually has
to be done in conjunction, in connection with redirecting negative thoughts
related to trauma, mood issues, to addiction triggers. You know, more often
eating disorders are not happening just on its own. It's usually related maybe
to trauma, childhood trauma or adulthood trauma, to addiction or to the mood dysregulation.
It's hard to just redirect negative self-talk related to nutrition. We need to
work on it, you know, altogether.

Jessica Griffith: I think overall sometimes it can be
a one-to-one with a provider, but I really think just collaborating with the
rest of the treatment team, including primary therapists or any other
professionals working with the resident just to help with that re-engagement.
Because when there's an increased negative self-talk or increase in maladaptive
behaviors, the treatment team can be really beneficial in reminding your a
resident like, "Hey, we're all on the same team, we're just not all on the
same sheet of music." And so, the whole intent is to get you better, and
you get to define that. I feel residents forget that they're also members of
their treatment team, and they're actually the ones inhibiting their own
progress.

Host: Yeah. And it just feels like what I'm hearing
today is that issues with food or sort of troubled relationships with food or
eating disorders, those types of things, there's almost always underlying root
causes, whether that's again, trauma, mood disorders, things like that. And
it's almost sort of a symptom of those things. So, you're kind of maybe
sometimes working your way backwards. Like, okay, someone comes in for an
eating disorder, but you're really trying to get at what caused the eating
disorder. Do I have that right?

Jessica Griffith: Yeah, absolutely. And you know,
again, eating disorders are a specific niche that not every healthcare provider
has training on. And so, again, they think we're talking about food groups and
they're wondering why I'm asking about childhood mealtimes. And for example,
come to find out, you know, they had food insecurity, maybe their parents were
addicts and so it was normal to them to be without food and how that can
disrupt their growth pattern and just how they see food and perceive it and,
you know, bullying, and there's just so many things. And the whole point is
recognizing like, "Hey, these are like little T's," which I refer to
little traumas, and those things add up to a big T where some things are
obvious to some residents. You know, if I have a veteran, you know, that's been
in combat, that's an obvious big T or sexual trauma, you big T. But all those
other little T's too, we can't discredit them.

Larisa Biznichuk: Absolutely. I very much agree with
Jessica. You know, those little T's definitely add up. And when clients are
coming and saying, "No, it was fine. We just sometimes didn't have food on
our table," yeah. It doesn't register--

Jessica Griffith: "Everyone skips meals. What
are you talking about?"

Larisa Biznichuk: Right.

Host: That was so normalized in their family, right?
They may just be finding out in their 30s or 40s, "Oh wait, that wasn't
sort of normal. That wasn't the case for everybody else, my friends at school,
whatever."

Larisa Biznichuk: Yeah, that's very much true. Yeah.

Jessica Griffith: Everyone has disordered eating. I
think that's the thing I try to normalize because there's no such thing as a
perfect diet. We're going to have preferences, we're going to have quirky
things because that's how we grew up. Like one of my girlfriends, she will not
drink anything until she finishes her meal, because she grew up with her
parents wanting to make sure she didn't drink her nutrition. And so, there's
just some things that stick with us that we don't even realize we do until they
have a dietician friend.

Host: It's nice to have a dietician friend, isn't it?

Larisa Biznichuk: And at the same time, you know,
there are some cultural preferences. You know, I'm from Eastern Europe and we
don't drink cold water. It's just not in my culture. And when I'm asking,
"Okay, don't put ice in my water, going to drink it," nobody
understands it here.

Host: Right. You don't have to heat the water up.
Just don't make it colder, right?

Larisa Biznichuk: Exactly. Yeah. Don't boil it.

Host: Hey, this has been really fun. Today, I'd just
kind of finish up on a little bit lighter one. Jessica, maybe you take this one
first. What are some things you see around the holidays? I know for me anyway,
I look forward to the holidays and sometimes I'll sort of like starve myself
for like the day before so that I have plenty of room for all the holiday food.
But generally speaking, what do you see?

Jessica Griffith: Well, one, I don't recommend that.
You need nourishment all the time. Honestly, I personally see an increase in
intensity around food restriction in multiple forms, whether that's dieting,
cutting out food groups, being mindful of calories, or, you know, macros,
eating less, just some sort of eating pattern requiring you to take in less
food.

I also have more conversations and comments related to diet
culture. For example, it's just I'll hear from my patients where it's like,
"I can't, I can't. I don't want to see my grandparents." And I'm
like, "Well, why?" "They're like, "They're just always like,
'Oh my God, you're so skinny!' Or like, 'Oh, you gained weight.'" And you
know, I get it. You see family members every now and then, and the first thing
they're going to comment on is what you look like, and that is so triggering
for people. And then, we get to the dinner table and it's like, "Okay,
great. They made comments about my body. Now, people are thinking twice about
what they're putting on their plate."

Host: Yep. It's so interesting. This has given me a
lot of, pardon the pun, but food for thought today. I'm really cognizant of
this, Jessica, because I have a 15-year-old daughter, you know, who's really
athletic and I have to remember what I feel like might be a compliment may not
be perceived as a compliment, especially if it's about her hair or how she
looks or how fit or athletic she seems, you know. So, I'm always sort of
cognizant of that, of be careful because that may not be perceived as a
compliment to her, right?

Jessica Griffith: For sure. And we're human and
people mean well. I think in general, the intent is to be positive. However, we
don't know people's struggles and stories. And unfortunately, they may
internalize it as, "Well, what does that mean about how I used to look
like?" Or "Did you not like me then?" And so yeah, trying to
make a conscious effort of, you know, complimenting people's like energy or
their vibe or just being a nice and good person. I mean, sometimes it just goes
back to the good old words of like, if you have nothing nice to say, don't say
anything at all.

Larisa Biznichuk: Yeah. Unfortunately, holiday
dinners can be very triggering for our clients and can bring a lot of trauma
memories. That's for sure.

Host: Yeah, definitely. Well, I feel like we could go
on and on and branch off into a bunch of different directions, but I'm not sure
Sierra Tucson wants that. We're going to leave this one for what it is. But I
hope that I get to speak with you both again and we can, you know, roll up our
sleeves and do some more good work and share this with listeners. So, I just
want to thank you both for joining me and you both stay well.

Jessica Griffith: Absolutely. Thank you so much.

Larisa Biznichuk: Thank you.

Host: And for more information, go to
sierratucson.com. And if you found this podcast to be helpful, please share it
on your social channels. And be sure to check out the full podcast library for
additional topics of interest. This is Let's Talk: Mind, Body, Spirit from
Sierra Tucson. I'm Scott Webb. Stay well.