Program Orientation
Two types of therapy have primarily been shown to be effective
in treating eating disorders, with most of the studies about bulimia
nervosa. These modalities are Cognitive Behavior Therapy (CBT)
and Dialectical Behavior Therapy. This program is based on those
modalities as developed by Dr. Christopher Fairburn and Dr. Marsha
Linehan.
For treatment of Binge Eating Disorder and Compulsive Overeating,
Dr. Jean Kristeller’s MB-EAT techniques and Dr. Fairburn’s
compulsive overeating program are used with DBT techniques.
While the treatment of eating disorders is considered quite
challenging, areas of concern that should be addressed have
been identified. Interpersonal relationships, core low self
esteem, clinical perfectionism, emotional dysregulation (or
mood intolerance) and body image are typically some of the issues
that are primary for patients with an eating disorder. Through
groups and individual therapy, these areas are addressed.
Initial Evaluation Sessions
To determine if this program could address your concerns and
help you meet your goals, initial evaluation sessions will include
a clinical history and completion of the EDE. Readiness for
change will be considered as well. In this interview the program
will be described in more detail so that an informed decision
as to whether to enter the program can be made.
Program Stages
In individual therapy the following phases will be followed,
with important goals for each phase. These goals may be modified
to meet the needs of the individual patient.
Phase I Pretreatment
Education
Addressing motivation to change
Assessing key features of the eating disorder
Building a therapeutic relationship
Presenting multiple functions of symptoms
Presenting the cognitive rational for treatment
Introduction of the DBT Diary Card
DBT Skills Training Group Contract
Phase II
Implementing initial cognitive interventions
Understanding the key features of the eating disorder for the individual
Presenting the cognitive rational for treatment
Implementing self-monitoring and meal planning
Prescribing normalized eating patterns
Interrupting bingeing and vomiting
Challenging cultural values regarding weight and shape
Phase III
Continued focus on weight gain and normalized eating
Challenging food avoidances
Reframing of lapses
Identifying dysfunctional thinking patterns
Modifying self-concept
Focus on interpersonal issues
Body Image assessment
Cognitive treatment of body image distortion
Phase IV
Summarizing progress
Reviewing fundamentals of continued progress
Summarizing areas of continued vulnerability
Reviewing the warning signs of relapse
Clarifying when to return to treatment, if necessary
Level I Outpatient
One individual session, one modified DBT skills training group
per week
Two family sessions
Level II Outpatient
Two individual sessions, one modified DBT skills training group
per week
Two family sessions
Intensive Outpatient Program
Two hours of individual therapy weekly, scheduled as to the
availability of the therapist and the patient. Seven hours of
group will be offered as follows:
Day 1
- DBT Skills Training Group
- Therapeutic Eating Group
- DBT Based Process Group
Day 2
- DBT Skills Training Group
- Nutrition Group/Body Image
Day 3
- CBT process group
- Goal Setting/Weekend Planning Process Group
Program Materials
Body Image Patient Workbook
DBT Workbook
Paths to Healthy Eating Workbook
Self Esteem Workbook
Aftercare
Continued medication management when indicated
Continued participation in DBT Skills Training Group, Modified for ED for another
six months
Continued access to books, tapes, and videos
Continued individual sessions as necessary
Weight monitoring with physician when indicated
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