Introduction to Eating Disorder Treatment Options
Whether you're beginning your search for a therapist or looking into more intensive treatment such as inpatient and residential care, the providers will usually let you know the type of therapeutic approach they use in advance. There are so many options; it can be overwhelming to decide where to start, but don't be discouraged. Options are good! The most important thing is to find out the best approach for your needs, and many therapists are trained in a variety of methods for this very reason. There are many paths to recovery! Treatment centers also generally offer a multimodal approach, allowing for a sampling of options, which can help guide your aftercare plans.
As funding for eating disorders research has increased over the years, many new modalities have been developed and researched. Overall, there really isn't one that is better than the other, but if you review the outcome studies, you will find two common themes. A combination approach usually comes out on top, and the therapeutic relationship between client and provider is of ultimate importance.
This isn't going to be a complex, scientific, compare and contrast of the therapies out there. More-so, it will be like Dave Letterman's top ten list to give you a general idea so when you're making those first phone calls or looking at the therapeutic approaches on treatment center websites, you will at least have a better idea of what all these crazy acronyms mean.
Psychodymamic – From the days of Sigmund Freud, this approach has been around for a long time and focuses on underlying issues and experiences, often linked to childhood, that cause a patient to create maladaptive behaviors and defense mechanisms. Basically, you work through past experiences with the hopes of understanding how patterns developed over time. Most therapists have training with this technique. In order to also deal with the current eating disorder behaviors, this approach works best when combined with other methods because what prompted a behavior is not always what sustains it.
CBT – CBT stands for Cognitive Behavioral Therapy and is integrated into the philosophy of most treatment centers. The approach helps clients acknowledge the relationship between their thoughts, feelings, and behaviors. It is used to teach the client to restructure their thinking in order to shift perspective or turn the mind. For example, a client may believe, "If I eat that piece of pizza, I'm going to get fat," and therefore avoid the pizza altogether. Through CBT, the therapist would work with the client to modify such thoughts into a more realistic, acceptable approach to eating. An example of a counter thought might be, "One slice of pizza is the appropriate portion and will give my body energy." CBT is also helpful when working with perfectionism. Due to the astounding number of studies that have been examined, CBT is one of the most widely used forms of treatment today.
IPT – Interpersonal Therapy was initially developed as a time-limited technique for those with depression. In regards to eating disorders, research has shown this to be most effective for people with bulimia and binge-eating disorder, especially when partnered with CBT. Due to its emphasis on relationships, longer treatment periods are necessary. Learning to manage conflict, change, and emotional responses without using eating disorder behaviors is a major focus of IPT. It is also a wonderful therapeutic modality for those who are socially isolated.
DBT – Originally developed to treat people with Borderline Personality Disorder, Dialectical Behavioral Therapy (DBT) is now becoming a very popular method of treatment for people with eating disorders and is frequently integrated into the therapeutic milieu of treatment centers. It focuses on four modalities: mindfulness, interpersonal effectiveness, distress tolerance, and emotional regulation. It teaches the client skills and methods to handle intense emotions and develop better ways to engage in a positive, assertive communication. The therapy usually consists of both individual and group sessions. While some find this manual-based approach boring, it can be extremely powerful when applied to everyday life. Sessions are spruced up with role-playing and interactive activities. It is important to find a qualified therapist with specialized DBT training. DBT Central is an online resource that can help you connect with a provider. Interestingly, Marsha Linehan, a professor at The University of Washington and the developer of DBT, recently publicized how she managed her personal struggle with borderline personality disorder with her own technique.
MEDICAL – The medical method is simply the incorporation of psychotropic medications to aid in the recovery of a mental health disorder. While you may hear personal accounts that "X" medication did wonders for someone, it is important to remember that everyone's neural pathways respond differently to each type of medicine. There have been numerous studies suggesting medication management can play a positive role in recovery, but it is rarely effective alone. When accompanied by other therapies and closely monitored by a qualified psychiatrist, medication may bring great relief to a patient.
MAUDSLEY – The Maudsley Method is a family based treatment approach most often used with children and adolescents. The opinions of Maudsley are mixed, and some would say the technique is controversial due to its intensity and dependence on the family unit. Not every family is willing and able to complete this type of treatment, but it does show a fairly promising success rate for families and teens motivated to make recovery the family's primary concern. Most often an outpatient approach, it can be accompanied by intensive outpatient support. There are also many clinics using Maudsley as part of their family therapy programs. Maudsley treatment includes three phases: weight restoration, returning control of eating back to the patient, and finally, helping the patient establish an identity outside of the illness. The online community "Around the Dinner Table" is a well-known support forum for parents going through the process with their child and offers many resources.
EMDR – Eye Movement Desensitization Therapy was initially developed for people with Post Traumatic Stress Disorder (PTSD) and other trauma related distress. There are eight phases of treatment where specific eye movements, body desensitization, and tapping are incorporated with the processing of traumatic events. The establishment of a strong therapeutic alliance between client and therapist is paramount when utilizing this powerful mind-body technique. Ensure you are choosing a qualified therapist, and remember you can always interview them. The EMDR network offers a more thorough explanation as well as how to find a good therapist.
12-STEPS – 12-Step groups, such as Eating Disorders Anonymous and Overeaters Anonymous, are available in almost every community, often daily, and free of charge. You can go to either group; they just change the wording. If you find a good meeting, the accountability, extra structure, and positive environment can be a really helpful recovery resource. Of additional interest, the 12 step programs utilize mentoring, opening up the possibility of adding another ally to your social support network.
INTEGRATIVE THERAPIES – There are a number of other holistic methods used to treat eating disorders. Often found in residential and inpatient facilities, yoga, massage and bodywork, psychodrama, dance and body movement, NIA (a sensory-based movement practice that borrows from martial arts and dance), art therapy, recreational therapy, and biofeedback are all examples. While these have not been researched as heavily yet, the field of neuroscience is unlocking the mystery to many of these techniques through the study of mindfulness and brain function.
One particular treatment that some consider "alternative" but is actually widely accepted is biofeedback, also known as neurofeedback. The client is connected to small electrodes that allow them to see their brain activity while working through various exercises. By learning to control the body's stress response, the client is able to relax the central nervous system. It is a wonderful alternative to medication for chronic pain, intestinal disorders, anxiety, and a number of other conditions relevant to eating disorders recovery.
The treatments and methods mentioned above are just a skimming of the surface from a patient perspective. Recovery is a journey that requires willingness over willfulness, and sometimes that is not an easy jump to make. In other words, recovery requires support, especially professional support.
When searching for treatment providers, keep in mind you are the customer. Many therapists and treatment centers offer a short interview free of charge so you can make informed decisions about your healthcare. Finding effective treatment can be hard, and sometimes it takes a lot of digging to find what is right for you. We have to be vulnerable, let our guard down, and learn to trust. If we don't get at the core of the disorder, the cycle often replays itself again.
Hopefully our alphabets will be a simple ABC soon!