Therapy

FBT is the gold standard, evidence-based treatment for adolescents with anorexia nervosa and bulimia nervosa. It can also be utilized when working with transition age youth. In stage 1 of FBT, parents are empowered to temporarily take complete control over refeeding their child. Therapists take a warm but firm, active stance to treatment, acting as expert consultants to families on the topics of eating disorders and recovery. Parents are taught how to distinguish and separate their adolescent from their illness (their eating disorder) and are coached on ways to compassionately approach the task of refeeding their loved one without getting pulled into negotiations with their loved one’s eating disorder. While our therapists may be the experts on eating disorders, we acknowledge that all parents that we work with are the experts on their own children; they intuitively know how to love, support, and feed their children better than anyone else ever could, including our therapists. Families play an invaluable role in helping their child restore themselves to an appropriate weight and reengage in normal eating patterns.

Stage 2 of FBT begins once the adolescent has sufficiently progressed towards goals of restoring their weight and/or has shown that they are able to eat regularly without significant resistance or challenges. Gradually and carefully, adolescents are given back control over their eating, and ultimately earn back their independence in this domain.

In stage 3 of FBT, we briefly work with families on more normative challenges that adolescents face during this time in their lives and help them get back to just being a kid.
Outpatient FBT typically entails 15-20 sessions over the course of 6-9 months.

If families with adolescents diagnosed with anorexia nervosa or bulimia nervosa are struggling to make progress in treatment in our Outpatient Eating Disorders Clinic, priority referrals are provided to our in-house Eating Disorders Intensive Outpatient Program (IOP)/Partial Hospitalization Program (PHP), or affiliated Inpatient Program.

CBT-E is a research-supported treatment for adults with anorexia nervosa, bulimia nervosa, OSFED, and UFED that on rare occasions, can be provided as a second-line treatment for adolescents when FBT cannot be provided. CBT-E directly 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.

Outpatient CBT-E typically entails 20-40 sessions, depending on whether weight restoration is indicated, initially meeting twice weekly with their therapist and decreasing session frequency as they progress in treatment.

For adults that struggle to make progress in treatment in our Outpatient Eating Disorders Clinic, our team is happy to assist in the referral process to other outpatient providers that specialize in alternative evidence-based treatments for eating disorders, including dialectical behavior therapy (DBT), radically open dialectical behavior therapy (RO DBT), or to other eating disorder treatment facilities in the community that offer higher level of care programming, including Monte Nido, Eating Recovery Center, Center for Discovery, and Eating Disorder Solutions.

CBT-AR is a treatment for adolescents and adults with ARFID, with aims of helping patients to normalize eating, increase macronutrient intake by directly consuming food rather than dietary supplements, and restoring weight and growth (if necessary). CBT-AR uses exposure-based interventions to address sensory sensitivities, lack of interest in eating, and/or fear of aversive consequences of eating (such as a fear of vomiting or choking). While CBT-AR has not yet undergone the rigorous testing necessary to be considered an evidence-based treatment for ARFID, initial studies have been quite promising, indicating that this approach is a well-accepted treatment.

Outpatient CBT-AR typically entails 20-30 weekly sessions, depending on whether weight restoration is indicated. Family-Based CBT-AR is provided for adolescents ages 12-16 and, 16-17 when the patient is underweight. Individual CBT-AR is offered for adults and motivated adolescents ages 16-17 that are not underweight as a result of their food avoidance/restriction.

For adolescents and adults with ARFID that struggle to make progress in treatment in our Outpatient Eating Disorders Clinic, our team is happy to assist in the referral process to other eating disorder treatment facilities in the community that offer higher level of care programming, including Monte Nido, Eating Recovery Center, Center for Discovery, and Eating Disorder Solutions.

Anxiety disorders/OCD are a common set of co-occurring diagnoses in patients with eating disorders. ERP is the gold standard treatment for anxiety disorders/OCD and can help 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.