I am putting the final touches on the workshop I have been invited to give next weekend (Nov. 9-11, 2012) at the Renfrew Conference in Philadelphia. This conference is always rewarding to attend. In the spirit of this year’s title, “Exploring Controversy and Building Collaboration,” my workshop is focused on the unique circumstances nutritionists who specialize in eating disorders are in. And that is that there is NO (none, naughta, nothing, zip, ZERO) research on nutrition counseling in the treatment of eating disorders. Some researchers in the field have argued, therefore, that this means nutritionists are not necessary for effective treatment. I know from my over 25 years of clinical experience and from the premier professional organization dedicated to eating disorders, Academy of Eating Disorders stance on treatment, that “eating disorders typically require a treatment team consisting of a primary care physician, dietitian, and a mental health professional knowledgeable about eating disorders.”
What’s a good nutritionist to do in this situation I asked myself. Dig deep into the research, go to all the conferences that I can afford, talk to other top clinicians, pay attention to what works and then beg, borrow, and steal (with attribution of course) from evidence-based approaches. My workshop distills my efforts to provide top-notch effective nutrition treatment for eating disorders. Here is the blurb from the Conference Brochure:
The New Alphabet Soup: ACT, CBT-E, DBT, FBT and MI-Based Nutrition Techniques
Marcia Herrin, EdD, MPH, RD, LD
Following a comprehensive review of ACT, CBT-E, DBT, FBT and MI techniques designed to address nutritional issues in the treatment of eating disorders, this presentation describes how to match therapeutic approaches to particular clinical situations and how to monitor effectiveness of approaches. Clinical examples are used throughout, including live demonstrations and a coached meal experience.
Long-time readers of this blog might remember way back in 2009, Nancy (my blogging and writing companion extraordinaire) posted Deciphering the alphabet soup of E.D. treatment options. In this post Nancy does an excellent job of describing how therapists use different psychological approaches CBT, DBT, or ACT. Notice that in less than four years we are now talking about ACT, CBT-E, DBT, FBT and MI. For those readers who can’t come to Philly to participate in my workshop (and for those that can attend please come say hello), below are the professional treatment guides and self-help workbooks that I have begged, borrowed, and stolen from:
Acceptance and Commitment Therapy (ACT)
The guiding principle of ACT is “Change with you do, not what you think or feel.” ACT focuses on indentifying core values and committing to action that leads one in a valued direction. ACT also focuses on stepping back or detaching from thoughts and feelings, accepting that it is normal to have painful or unpleasant experiences. ACT points out that being focused on feeling good, being right, managing anxiety, handling depression can distract us from the bigger picture and our values.
Heffner, M., Eifert, G. H., & Hayes, S. C. (2004). The anorexia workbook: How to accept yourself, heal your suffering, and reclaim your life. Oakland, CA: New Harbinger.
Sandoz, E. K., Wilson, K. G., & DuFrene, T. (2010). Acceptance and commitment therapy for eating disorders: A process-focused guide to treating anorexia and bulimia. Oakland, Calif: New Harbinger Publications. [for professionals]
Sandoz, E. K., Wilson, K. G., & DuFrene, T. (2011). The mindfulness and acceptance workbook for bulimia: A guide to breaking free from bulimia using acceptance and commitment therapy. Oakland, CA: New Harbinger Publications.
Cognitive Behavior Therapy (CBT, CBT-E)
CBT-Expanded to treat anorexia nervosa as well as bulimia and binge eating disorder (BED). CBT is most evidenced-based approach for bulimia and BED and is based on the idea that you can change negative behaviors by changing your way of thinking. CBT-E is also pared down from standard CBT to primarily focus on food related interventions. The guiding principle is to “do a few things well rather than many things badly.”
Agras, W. S., & Apple, R. F. (2008). Overcoming eating disorders: A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder: therapist guide. Oxford: Oxford University Press.
Apple, R. F., & Agras, W. S. (2008). Overcoming your eating disorder: A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder. Oxford: Oxford University Press.
Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders. [for professionals]
Dialectical Behavior Therapy (DBT)
DBT teaches patients how to replace disordered behaviors with more skillful behaviors and how to tolerate negative emotions. DBT works to give people a very clear and step-by-step understanding of their difficulties by identifying what particular behaviors, situations, thoughts, feelings cause problems and what new behaviors and skills can prevent problems. DBT also focuses healthier ways to handle painful emotions by recognizing and accepting feelings without judging them as “good” or “bad.”
Astrachan-Fletcher, E., & Maslar, M. (2009). The dialectical behavior therapy skills workbook for bulimia: Using DBT to break the cycle and regain control of your life. Oakland, CA: New Harbinger Publications.
Safer DL, Telch CF, Chen EY (2009). Dialectical behavior therapy for binge eating and bulimia. [for professionals]
Family-Based Treatment (FBT)
We have talked a lot about FBT in this blog and have written one of the parent resources mentioned below. FBT clinicians teaches parents to play an active role in restoring weight and normal eating patterns in their eating disordered child. Once this is accomplished parents are coached in how hand the control over eating back to the adolescent, and encourage normal adolescent development.
Alexander, J., & Le, G. D. (2010). My kid is back: Empowering parents to beat anorexia nervosa. London: Routledge.
Brown, H. (2010). Brave girl eating: A family's struggle with anorexia. New York: William Morrow.
Lock, J., & Le, G. D. (2012). Treatment manual for anorexia nervosa: A family-based approach. New York: Guilford. [for professionals]
Lock, J., & Le, G. D. (2005). Help your teenager beat an eating disorder. New York, NY: Guilford Press.
Treasure, J., Smith, G., & Crane, A. (2007). Skills-based learning for caring for a loved one with an eating disorder: The new Maudsley method. London: Routledge.
Motivational Interviewing (MI)
MI techniques help patients recognize problems and then make informed decisions about whether or not they want to work on change (e.g., I won’t be able to run track if my weight is as low as I want it to be). The goal of MI is to help the patient identify reasons to work toward change. Clinicians are encouraged to adopt a curious and empathic stance, to highlight options and to emphasize that patients are ultimately responsible for change.
Arkowitz H, Westra HA, Miller WR, and Rollnick S. (2007). Motivational Interviewing in the Treatment of Psychological Problems. [for professionals]
Myers, E. S. (2006). Winning the war within: Nutrition therapy for clients with eating disorders. Lake Dallas, Texas: Helm Publishing.
Rollnick, S & Miller, WR (2007). Motivational Interviewing in Health Care: Helping patients Change Behavior. [for professionals]
Nutritionist Marcia Herrin and Nancy Matsumoto, co-authors of The Parent’s Guide to Eating Disorders, Gūrze Books. Marcia is also author the soon to be published Nutrition Counseling in the Treatment of Eating Disorders (September, 2012). Read more from Marcia and Nancy by clicking here.Copyrighted by Marcia Herrin and Nancy Matsumoto