Effective treatments have evolved over the previous 30 years advancing mental health care. For example, Cognitive-Behavioral Therapy, Dialectical Behavior Therapy (DBT) and Family based treatments have proven effective for the treatment of eating disorders. The common component amongst these treatments is prioritizing the eating disorder symptoms as life threatening and intervening directly with the factors that maintain the problem behavior (i.e. calorie restriction, bingeing, purging, laxative abuse, over-exercise, compulsive weight checking, weight avoidance). Unfortunately, few patients actually receive this form of therapy once they enter into treatment. Why you ask? Good question. Below are 3 common treatment myths which impede recovery from an eating disorder.
Myth #1: Patients should not view their weight during treatment
This particular myth continues throughout the treatment community although it is in direct opposition to contemporary scientific understanding of treatment for emotional disorders. The truth is our most effective treatments for eating disorders incorporate collaborative weight monitoring as a critical component of recovery. Both Family Based Treatment (FBT) and Enhanced Cognitive Behavioral Therapy for Eating Disorders (CBT-E) consider exposure to weight to be important in both monitoring treatment effectiveness and therapeutically intervening with core features maintaining disordered eating. Weighing the patient, and allowing the patient to view their weight, strengthens the therapeutic relationship by helping the patient through a potentially stressful process. The anxiety created around viewing weight is a critical treatment target as the avoidance of anxiety related to weight gain maintains disordered eating. When exposed to their weight, patients learn skills to experience and tolerate this emotion versus pathological avoidance of anxiety (purging, calorie restriction, over-exercise). As is the case with empirically supported treatments for a wide range of anxiety disorders, exposure to feared objects (in this case weight or food) is essential for the patient to eventually tolerate the emotion and decrease the intensity of distress. In addition, Eating disordered beliefs are triggered and core treatment interventions are employed to help the patient identify maladaptive and distorted thinking that maintain problematic eating patterns. Patients in treatment for an eating disorder require assistance in coping with the fear of weight gain, education on healthy eating, skills to tolerate distressing emotions, skills to challenge ED beliefs, and behavioral shaping of new more healthy coping skills. When therapists support blind weigh in’s they are limiting their ability to therapeutically intervene with core features maintaining disordered eating. Finally, and probably most important, supporting avoidance of weight undermines the patient’s ability to cope with fear and essentially hands over control to the eating disorder. Patterns are now set that support a treatment that avoids “triggers” versus a treatment that supports effective coping with the inevitable anxiety and distress associated with living life.
Myth #2: Therapists should not be responsible for weight monitoring
A common and dangerous myth associated with ineffective therapies that outsource the weight monitoring to nutritionists and physicians. Rationally speaking this practice makes little sense. First, the therapist is often the lone member of the treatment team with expertise in effective psychotherapy interventions to support recovery. These occur in the safety and structure of an established psychotherapy relationship where the intimate knowledge gained through this process supports new ways of coping. As mentioned earlier, exposure to weight and monitoring of eating disorder behavior provides opportunities for necessary therapeutic intervention. As many of my eating disordered patient’s proclaim when they resist nutritional counseling, “I am not eating disordered because I lack the knowledge of healthy nutrition!” This is often true and eating disorders are an emotional disorder requiring intervention from an expert in the treatment of emotional disorders. Physicians and nutritionists, important members of the treatment team, do not have the time nor expertise to intervene effectively with the myriad of complex factors influencing disordered eating. In addition, the therapist is likely the treatment team member with (1) the most frequent interaction with the patient and thus able to more effectively monitor factors influencing weight; and (2) has the best rapport and relationship with the patient. Thus, it is necessary for therapist’s to incorporate collaborative weight monitoring and exposure in treatment.
Myth #3: Psychotherapy should address the “underlying cause” of the eating disorder and not the “symptoms”
This myth is particularly dangerous because eating disorders are potentially life threatening and positive treatment outcomes are associated with early symptom reduction. Medical complications associated with starvation, self-induced vomiting, and laxative/diuretic abuse are potentially irreversible if prolonged and severe. The contemporary understanding of eating disorders acknowledges the multiple factors influencing the development of eating disorders, which may or may not be driven by psychological conflict or emotional trauma. Those treatments that seek to target only underlying psychological conflicts/emotional trauma are at risk of (1) providing an unsupported and ineffective treatment for an eating disorder; (2) addressing the psychological conflict and/or emotional trauma at a time when the individual is too ill to benefit from the treatment; and (3) actively impeding the focus and progress toward resolving potentially life threatening behavior. Eating disorders often represent maladaptive coping responses and unless this is actively targeted in therapy the patient will likely continue to respond with behavioral patterns that are self destructive. Finally, the longer the eating disorder symptoms remain the greater the risk of treatment drop out. It only makes sense, why stay in a treatment that is not helping resolve the actual problem that brought the patient to therapy in the first place.
Center for Integrated Behavioral Health in Bethlehem, PA offers evidence-based outpatient treatment for eating disorders. Available treatments include Enhanced Cognitive-Behavioral Therapy for Eating Disorder (CBT-E), Family Based Therapy (FBT), and full model Dialectical Behavior Therapy (DBT). Please call 610-865-4300 or visit our website at www.centerforibh.com for more information.