Eating Disorders IOP/PHP

Eating Disorders Intensive Outpatient & Partial Hospitalization Programs (IOP/PHP)

The UTHealth Houston Center for Eating Disorders uses a stepped-care approach to the treatment of adolescents with anorexia nervosa and bulimia nervosa. Adolescents receiving treatment in our Outpatient Eating Disorders Clinic will almost always be provided with a course of family-based treatment (FBT), the gold standard treatment for adolescents with eating disorders. If families and their loved ones are struggling to improve at our outpatient level of care, or simply desire more support, our stepped-care approach to treatment allows us to seamlessly provide patients with the same support at higher levels of care, while systematically integrating additional evidence-based treatments that are shown to be effective in addressing their eating concerns. Given the impracticality of parents being able to attend full days of IOP and PHP with their loved ones, our higher level of care programs will continue to support parents in implementing FBT during breakfast at our Center, and while their child is at home and outside of program. Their child will concurrently be provided enhanced cognitive behavior therapy (CBT-E), where they will have the opportunity to work independently on dismantling their eating disorder. CBT-E is a research-supported treatment that targets an individual’s thoughts and behaviors that contribute to their “over-evaluation of body shape and weight”. This tendency for individuals to become preoccupied with their body shape and weight and use their body shape and weight as a major source of self-esteem is often central to the core pathology of eating disorders.

In providing a multi-step, concurrent, family, and individual approach to treatment, we seek to provide our patients with the support they need to overcome their eating disorders within the least restrictive environment possible. When sufficient progress is made in our higher level of care programs, patients and their families are able to step back down to the Outpatient level of care to continue addressing their eating disorder.

Intensive Outpatient Program (IOP)

At the UTHealth Houston Center for Eating Disorders, our IOP has a core curriculum that adheres to the “Focused” form of CBT-E for all patients in program, as well as individualized group curriculum specific to their presenting concerns, including Binge-Specific CBT-E groups, and Underweight-Specific CBT-E groups. We also provide groups consistent with the “Broad” form of CBT-E to target maladaptive perfectionism, core low self-esteem, marked interpersonal difficulties, and/or mood intolerance, when we believe these problems may be contributing to a patient’s eating disorder. Parents will receive ongoing support in implementing Family-Based Treatment (FBT) during breakfast at our Center, and while their teen is at home and outside of program.

Anxiety disorders/OCD are a common set of co-occurring diagnoses in patients with eating disorders. For this reason, we have an assimilative integration of ERP, the gold standard treatment for anxiety disorders/OCD, into our core CBT-E framework to enhance a patient’s ability to not only eat, but to do so in a way that can ultimately lead to improved tolerance of anxiety. ERP is additionally beneficial in disproving patients’ maladaptive beliefs related to the overestimated probability (how likely a negative outcome will occur) and cost (how awful it will be) of increasing food consumption and associated body changes.

Partial Hospitalization Program (PHP)

If individuals continue to struggle to make sufficient gains in our Outpatient Eating Disorders Clinic and IOP, or are at heightened risk for inpatient hospitalization, they are admitted to our PHP. We offer a continuation of our IOP’s concurrent FBT, and assimilative integration of ERP into our core CBT-E framework, and extend our treatment model to include two, individualized Therapy Tracks:

1. Dialectical Behavior Therapy (DBT)
2. Radically Open Dialectical Behavior Therapy (RO DBT)

Our Individualized Therapy Tracks provide two distinctive treatments that target core personality pathology that can often contribute to a patient’s eating disorder behaviors.

Our DBT Track incorporates core principles, skills, and interventions that target emotion dysregulation, and disorders of “under control”, where individuals struggle with high emotional sensitivity, impulsivity, interpersonal challenges, and difficulties with managing their emotions. DBT embodies a balanced approach of both acceptance and change, incorporates four skills modules that cover mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness, and has aims of helping patients to become more effective at managing their emotions and behaviors, and creating a live worth living.

Our RO DBT Track utilizes theory and techniques from a distinctive evidence-based treatment, that specifically targets disorders of “overcontrol”. Individuals that are “overcontrolled” display too much self-control, and struggle with low receptivity and openness, difficulties with flexible responding, low emotional awareness and expression, and struggle to form intimate interpersonal relationships. These difficulties can contribute to patients quietly suffering with social isolation, feelings of loneliness, and difficulties with interpersonal functioning, even though their suffering may not be apparent. RO DBT is unique in that it targets patient’s maladaptive social signaling (any behavior that is carried out in the presence of another person) whereby patients learn how to become more playful and flexible, take life less seriously, express their emotions and vulnerabilities more openly and candidly, as well as ways that they can signal cooperation with others. Ultimately, the goal of RO DBT is to help patients to “rejoin the tribe”, increase their social connectedness, and to create a life worth sharing.

As individuals learn and implement the respective DBT and RO DBT skills across their time in PHP, they can continue to generalize these skills and address their eating disorders at a stepped down level of care.