Evidence-Based Treatment at Anxiety Experts

We use two primary evidence-based theoretical orientations at Anxiety Experts:

Exposure with Response Prevention (ERP) and Acceptance & Commitment Therapy (ACT).

Below are explanations of each for introductory purposes.

Overview of Family-Based Treatment

What is Family-Based Treatment?

Family based treatment (FBT), also called the “Maudsley approach,” is a specific type of intensive outpatient treatment that is considered the gold standard for treatment of restrictive eating disorders among teens and young adults. FBT is based on the understanding that eating disorders take over teens’ and young adults' thoughts and behaviors, and prevent them from making rational and healthy decisions about food, exercise, and their body. Given the power that an eating disorder can have over a their choices, FBT requires that parents play an active role in helping their teenager or young adult restore weight and normalize their eating habits. FBT is divided into three phases in order to gradually return control to teenagers and young adults when appropriate.

What are the Phases of FBT?

  1. Weight Restoration: Since malnutrition has many negative medical, emotional, and cognitive consequences, restoring weight is the first priority. Research studies have found that the sooner that teens and young adults with eating disorders are able to treat malnutrition and restore weight, the greater their likelihood of fully recovering from their eating disorder. FBT requires that parents prepare and serve their teen or young adult meals and snacks that are consistent with family preferences, including the foods their teen or young adult enjoyed before the onset of their eating disorder. A doctor and dietitian who specialize in eating disorders can meet with parents to discuss a teen or young adult's energy needs, and the amount and rate of weight gain recommended during this phase.

  2. Returning Control over Eating to the Adolescent: Once their weight is restored through parent-managed meals and snacks, the teen or young adult may be ready for phase two. In this phase, parents begin to transition control over eating and exercise back to the them. For example, parents may allow the teen or young adult to portion their own veggies at dinner or allow them to choose whether they would like cookies or chips for a snack. Parents continue to provide support and supervision during this time.

  3. Establishing Healthy Adolescent Identity: This phase begins when weight stabilizes within a normal, healthy range based on the teen or young adult's development and when eating and exercise are normalized. They gradually gain more autonomy and develop a healthy relationship with parents without their disordered eating being central to their interactions. For example, they are able to enjoy eating and engage in conversation with friends and family without thoughts about food, nutrition, or their body impacting them in this final phase.

Is FBT for Me?

FBT is considered the first-line of psychological treatment for adolescents or young adults living at home with anorexia nervosa and also for some with bulimia nervosa. However, there are situations when FBT may not be a good fit for teens (or young adults)  and their families. For example, parents who are unable to be involved during meal times, and parents with a history of eating disorders or who are on restrictive diets can make FBT challenging. Your teen or young adult’s eating disorder team can discuss with you further whether FBT may be a good fit for your teen (or young adult) and your family.

 

How could a dietitian help with FBT?

A Registered Dietitian is completely different from a nutritionist (a nutritionist is not credentialed- anyone can use this label). Here are 10 reasons why a Registered Dietitian who specializes in eating disorders can be a consultant to parents during different stages of their teen or young adult’s eating disorder recovery:

An Eating Disorder-Specialized Dietitian...

  1. Understands that 80% of people with eating disorders also have anxiety, OCD, depression, or substance abuse; balances nutrition guidance with knowledge about how other mental health problems impact food choices.  

  2. Is trained to discern even the smallest of disordered eating behaviors from “normal” eating behaviors and attitudes, which may otherwise grow into a full-blown eating disorder if not monitored and challenged. 

  3. Will meet a client where they are while treating the eating disorder, and help a client and/or their family feel empowered to take on food challenges and develop a more freeing relationship with food. 

  4. Well versed in interpreting and understanding genetic growth patterns and recognizes how weight and body composition are highly individualized. 

  5. Is able to discern readiness for change, collaborating with the client to support an individualized treatment process.

  6.  Will create and provide a structured meal plan that focuses on variety and steps away from rigidity or “feeling like another diet”. 

  7. Is trained in screening protocols for the many types of eating disorders. 

  8. Utilizes neutral food and body language, such as “all foods fit,” “weight neutral approach,” “all food has value,” “joyful movement,” or “weight rehabilitation.” Words matter and help to reduce client harm.

  9. Is degreed and licensed to practice Medical Nutrition Therapy. Has extensive training in the eating disorder field, including experience with Family Based treatment (FBT) and Health At Every Size (HAES) concepts. This unique skillset allows the specialized dietitian to work closely with families and caregivers to optimize treatment outcomes. This specialty training is gained during years of treating disordered eating at all levels of care, while receiving supervision and training from experts. Registered dietitians (RD's) are not nutritionists, which is an industry that is totally unregulated.

  10. Understands the importance of collaboration within a team. The gold standard of care for eating disorder treatment is multidisciplinary, including therapist, registered dietitian and primary care physician or psychiatrist.

 

 

Parent Resources- To Learn More:Families Empowered and Supporting Treatment of Eating Disorders: www.feast-ed.org/

Support for Maudsely Parents: www.maudsleyparents.org/whatismaudsley.html 

Lock J, Le Grange D. Helping Your Teenager Beat an Eating Disorder (2015).Brown, H. Brave Girl Eating (2011)

“One Spoonful at a Time” article: www.nytimes.com/2006/11/26/magazine/26anorexia.html

Understanding Eating Disorders- Guide for Parents: youngwomenshealth.org/wp-content/uploads/2014/10/Understanding-Eating-Disorders-Parents.pdf

References:1. Madden, Sloane, et al. "Early weight gain in family-‐based treatment predicts greater weight gain and remission at the end of treatment and remission at 12-‐month follow-‐up in adolescent anorexia nervosa."International Journal of Eating Disorders48.7 (2015): 919-922.

2. Le Grange, Daniel, et al. "Early weight gain predicts outcome in two treatments for adolescent anorexia nervosa."International Journal of Eating Disorders47.2 (2014): 124-129.

Anxiety Experts arrow.png

When applicable,
we also treat patients using
Family Based Treatment.

What is ERP?

ERP is the number one treatment for anxiety.  ERP is a type of Cognitive Behavioral Therapy (CBT), which is the number one treatment for depression; however, CBT did not work as well for anxiety in the clinical research, so ERP was developed by Edna Foa and her colleagues. Everyone has anxiety, but some people drive their anxiety up by doing the three things that anxiety lives on:  Avoidance, Reassurance-seeking and Compulsions (also called rituals). These three behaviors are referred to as Safety Behaviors because they create the illusion of safety or certainty (which no one can have).

 

The focus of ERP is to help people stop doing the Safety Behaviors that make their anxiety worse and instead learn to accept the uncertainty and discomfort that people with lower levels of anxiety are better able to accept.  This is done in two steps:

 

EXPOSURE: This slowly exposes people to the things that make them anxious.  Sometimes this involves thinking thoughts on purpose that the person has been trying not to think.  Other times this involves going into situations that a person has been avoiding.

 

RESPONSE PREVENTION: This involves having the person let their anxiety come while they refuse to do the usual safety behaviors of avoidance, reassurance-seeking, or compulsions.

 

Every time a person resists safety behaviors and accepts the uncertainty this creates, it becomes easier to resist doing them in the future, and baseline anxiety becomes lower over time.

What is ACT?

Acceptance and Commitment Therapy (ACT) teaches people to make their own happiness in life (rather than waiting for it to come along accidentally), by going after things they value.  Values are the things people care about most, things worth living for.  ACT focuses on ACCEPTING thoughts and emotions (which can be very unpleasant a lot of the time), while COMMITTING to living by values anyway (ergo the ACT acronym).  This means that a person can still be doing something meaningful (things that bring them closer to the life they want), while they are having very distressing thoughts and emotions. With ACT, we learn to pursue a rich, full, meaningful life while tolerating the pain that inevitably comes with it.