Academy for Eating Disorders
#ICED2015

Workshops


Workshop Session 1 | Workshop Session 2 | Workshop Session 3


Workshop Session I
Thursday, April 23, 2015
2:30 – 4:00 p.m.

A.
Virtually Recovered: Using Blogs, Video Chats, Support Groups and Apps to Meet the Needs of Patients, Practitioners and Caregivers

Lori Lieberman, MPH, RD, United States; Sarah Ravin, PhD, United States; Laura Collins Lyster-Mensh, MS, United States; Cate Sangster, BSc, MA, Australia

Eating disorder sufferers go online seeking guidance regardless of whether or not the medical community supports it. Given the wealth of pro Ana and Mia sites, the degree of nutrition misinformation, and inappropriate messages about eating disorder recovery it may seem wise to discourage patients from utilizing online sites. Yet online interactions may greatly complement conventional medical treatment and enhance our connection with patients, prospective patients and caregivers. A dietitian, psychologist, parent advocate and author/advocate in recovery (most of whom first connected virtually between Australia and the US) discuss the unique benefits and potential risks of extending care virtually including:

  • Video chat—an option that extends our reach to those with limited local resources. This session will address how to protect ourselves professionally as we attempt to meet our patients’ needs. Clinical considerations, HIPPA and license issues for the clinician and dietitian will be reviewed;  
  • Online food record apps—from My Fitness Pal to Recovery Record, which can be both a barrier to change (providing misinformation) or an extension of our services. A creative approach for using record keeping apps as a support between session will be presented;  
  • Virtual support groups and blogs for eating disorder sufferers and caregivers—what’s out there and how professionals can utilize these to maximize their care.  

Patients vary in their readiness for change and these novel resources can help engage them whether they are precontemplative, in action or recovering from a slip. The value of anonymity, honesty and trust will be addressed as a contrast to the experience in the non-virtual world.

Learning Objectives:

  • Participants will be able to list and describe three types of online recovery options currently in common use.
  • Participants will be able to describe both the benefits and potential risks of  video chatting by therapists and dietitians.
  • Participants will be able to distinguish characteristics and use of apps that support versus hinder recovery efforts.

B.
Involving Patients and the Public in Research: Global Perspectives, Opportunities and Collaborations
Susan Ringwood, BA, FAED, Beat, United Kingdom
Involving patients and the public aims to enhance the quality, appropriateness, acceptability and relevance of research. This workshop will cover the context of patient and public involvement in clinical and academic research, giving a brief historical overview and a summary of current practice drawn from global examples. Developing the theme presented by Prof Cynthia Bulik in her keynote talk for ICED2015, the workshop will present a rationale for involving patients and the public in research, and invite debate on this premise. A specific exemplar will be presented: Charlotte’s Helix. The workshop will describe how via Charlotte’s Helix, families and individuals affected by eating disorders are being motivated and engaged to support and participate in research, by contributing data, research funds, and raising awareness by advocating for building on our knowledge base. The workshop will consider the impact of public involvement, and include discussion among participants of the pros and cons of involving patients and other stakeholders, which include potential bias, influence and the expectations of research outcomes. We will explore the realities of public involvement, its challenges, benefits and difficulties. The workshop will guide participants in identifying good practice principles for successful involvement in research, and understand how it relates to research design and execution. Examples of global initiatives will be shared, as will opportunities to collaborate in future and current studies.

Learning Objectives:

  • Identify good practice principles for successful patient and public involvement in research.
  • Interpret the application of patient and public involvement principles in research design.
  • Measure impact of  patient and public involvement in their own research practice.

C.
Examining Food & Mood: Affect, Eating Behavior and Implications for Treatment in Anorexia Nervosa

Joanna Steinglass, MD, United States; Loren Gianini, PhD, United States; Stephen Wonderlich, PhD, FAED, United States; Jason Lavender, PhD, United States

Affect may play an important role in restrictive dietary intake and other eating disordered behaviors in anorexia nervosa (AN). As such, further exploration of the complex relationships between affective experiences and disordered eating should be undertaken with an eye towards how this information can be creatively applied in improving treatment outcomes. This workshop will focus on data from a range of perspectives which examine affect and eating disordered behaviors in eating disorders and will discuss how these data pertain to treatment of AN. Dr. Lavender will present data using ecological momentary assessment (EMA) to look at affect in relation to binge eating, restriction, and other eating behaviors in the everyday lives of individuals with eating disorders. Dr. Gianini will describe the quantification of aberrant behaviors during a video-recorded research meal and these behaviors’ relationships with anxiety and caloric intake in a sample of patients with AN. Dr. Steinglass will discuss affect and food choice in AN in the context of a neurocognitive task that measures decision-making around food. Dr. Wonderlich will discuss using psychological intervention to improve affect regulation and will facilitate a discussion bringing together the data from the previous presenters to apply these techniques to the treatment of AN. Each speaker will present for 20 minutes, with 10 minutes allotted for discussion.

Learning Objectives:

  • Describe the relationship between affect and eating disordered behaviors in the everyday lives of individuals with eating disorders.
  • Describe the relationship between mealtime behaviors, affect, food choice, and caloric intake in patients with anorexia nervosa.
  • Describe how knowledge of relationships between affect and disordered eating behaviors can inform the development of treatments for anorexia nervosa.

D.
Treatment Avoidance in Anorexia Nervosa: Ethical Issues and a Pragmatic Approach to Treatment Refusal in the Severely Ill Patient

Angela Guarda, MD, United States; Colleen Schreyer, PhD, United States; Isis Elsakkers, MD, MSc, Netherlands; Graham Redgrave, MD, United States

Ambivalence towards treatment is characteristic of anorexia nervosa, and engaging patients in behavior change is a crucial hurdle faced by clinicians.  Given the high morbidity and mortality associated with anorexia nervosa, starvation's tendency to diminish patient's capacity to reason and the likelihood of recovery with treatment, an argument exists for the judicious use of some coercive pressure to help oblige patients into treatment.  Pressures range from gentle persuasion to legal certification, yet the use of coercion and its place in treatment remains controversial, with limited research to guide practitioners on how to manage treatment refusal in severely ill patients.  This workshop will provide an overview of the literature on treatment refusal, including competency and capacity to consent to treatment, perceived coercion during the hospital admissions process and compulsory treatment. New data will be presented on perceived coercion concerning hospital admission and on competency to refuse treatment in patients with anorexia nervosa.  The presentation will close with a case study addressing ethical dilemmas and the therapeutic value and role, if any, of coercive interventions. A suggested practical approach for assessing capacity and managing treatment resistance will be discussed, including directions for future clinical research.

Learning Objectives:

  • Summarize the literature on involuntary treatment and perceived coercion around hospital admission for anorexia nervosa.
  • Assess mental capacity and apply the outcome in clinical decision making regarding compulsory treatment.
  • Describe a practical approach to dealing with the ambivalent or poorly motivated patient and a reasoned approach to managing treatment refusal in anorexia nervosa.

E.
The Use of Family Meals in the Context of Single Family Therapy, Multi-Family Therapy and Intensive Day Treat Treatment for Anorexia Nervosa

Ivan Eisler, PhD, FAED, United Kingdom; Mima Simic, MD, United Kingdom; Esther Blessitt, MSc, United Kingdom; Stamatoula Voulgari, MSc, United Kingdom; Natasha Simpson, BA, United Kingdom; Gladys Ellis, MS, United Kingdom; Dianne Russell, MSc, United Kingdom

The aim of this clinically oriented workshop is to provide an overview of the evolving conceptualization of using family meals in the treatment of adolescent anorexia nervosa. The family meal is often considered to be a central intervention used in working with families with a young person suffering from anorexia nervosa.  Introduced in the 1970s as the “lunch session” at the Philadelphia Child Guidance Clinic (Rosman et al 1975) and modified in the early Maudsley studies in the 1980s and 1990s (Dare et al 1990), it has probably become best known through its description and clinical/research application in the Lock/Le Grange treatment manual for anorexia nervosa (Lock et al 2001; Lock & Le Grange 2013). In more recent years the family meal has evolved in the context of multi-family therapy and increasingly is also being used as part of day or residential treatments. The Maudsley Child and Adolescent Eating Disorders team has developed a number of different ways of using family meals, the choice of which depends on the stage of treatment and treatment setting. Case vignettes and video examples will be used to illustrate the practice. Participants will have the opportunity to discuss how these can be used in their own clinical practice, the potential pitfalls and how these can be addressed.     
Structure of workshop:   

  • Historical overview of the development of the family meal and it’s changing conceptualizations (20 min)
  • Group discussion (15 min)  
  • Description and discussion of the different types of family meals with presentation of clinical vignettes and case examples of how family meals were used in (40 min):   

    a) Outpatient single family therapy 
    b) Outpatient multi-family therapy 
    c) Day programme parent training and coaching 
    d) Day programme multi-family family sessions   
    Small group discussions to generate questions about possible pitfalls and discussion (in whole group) of ways in which different family responses can be managed in clinical practice   

  • General discussion (15 min)


Learning Objectives:

  • Describe the changing theoretical constructs that underpin the use of the daily meal in clinical practice.
  • List the different types of family meals and their suitability at different stages of treatment and different types of treatment settings.
  • Judge the suitability of applying the different types of daily meals in their own clinical setting.

F.
Launching Individuals with Eating Disorders to College and University: A Multi-Modal Approach for Working with Individuals, Parents and Clinicians

Gina Dimitropoulos, PhD, MSc, LMFT, Canada; Allison Darcy, PhD, MPsych, BA, United States; Kristen Anderson, MSW, United States; Daniel Le Grange, PhD, MA, FAED, United States; Kara Fitzpatrick, PhD, MA, BA, United States

The developmental stage of emerging adulthood is associated with multiple developmental transitions, including the movement from secondary to post-secondary education. During the transition from adolescence to adulthood, individuals with eating disorders are  vulnerable as they are likely to drop out of eating disorder treatment or under-utilize mental health services.  Attending college and university is also fraught with challenges as young people experience increased academic demands and the exploration of sexual identity and intimate relationships.  Even adolescents who have recovered from an eating disorder are at risk of relapsing as they achieve greater independence from their parents and increased autonomy over eating.  In this interactive workshop, we will outline a multi-model approach including a family based intervention targeting adolescents with a current or past history of an eating disorder as they launch into post-secondary school.  We will begin the workshop by examining how to assist families to provide developmentally appropriate support while promoting autonomous decision making in young adults. Workshop participants will then learn how to prepare treatment contracts and relapse prevention plans that can be developed collaboratively with young adults and their families prior to commencing their post-secondary education.  Participants will learn how to foster enhanced communication and strong relationships with student health services.  Through small and large group discussions, clinicians will identify challenges associated with campus life and ways to support effective coping with the myriad changes that may contribute to the emergence or exacerbation of eating symptoms and body image struggles.   Given recent strides in mobile health applications and the ubiquity of smartphones among young adults, we will examine how technology such as smartphone self-monitoring applications can be utilized by young adults and their families to facilitate recovery, and support ongoing health.

Learning Objectives:

  • Describe the challenges that are unique to young people with a current or past history of an eating disorder transitioning to post-secondary education.
  • Describe a multi-model intervention for young people and their parents which can be delivered by clinicians working in student health services and community mental health services.
  • Discuss novel use of technologies such as smartphones to assist young people to self-monitor while facilitating their connections to professional and informal support networks.


G.
Confident Body, Confident Child: How to Deliver the Evidence-based Positive Body Image and Healthy Eating Resource to Parents of Young Children

Laura Hart, PhD, BSc, BA, Australia; Stephanie Damiano, PhD, BSc, Australia; Susan Paxton, PhD, FAED, Australia

Parents provide a crucial environment in which young children develop body image attitudes and eating patterns. However, there are few evaluated resources to support parents in developing their child’s positive body image and healthy eating behaviors. Confident Body Confident Child (CBCC) is a new resource to assist parents in providing a positive body image and healthy eating environment for their 2-6 year-old children. The print materials, website, poster and information session were developed from the latest evidence and have been evaluated using a randomised controlled trial (RCT). Although the materials are self-explanatory, our RCT indicates that the resource has most impact when described to parents in an interactive information session. This workshop is designed for health or education professionals who would like to present the resource to parents of pre-schoolers, to encourage prevention of body dissatisfaction and disordered eating in children.  

The workshop will be divided into sections. First, the research background to the resource, why it is needed, and supporting evidence will be presented (10 min). Second, the most recent data on the development and evaluation of CBCC will be described (15 mins). Third, an interactive introduction and overview of the resource will be provided (15 mins). Fourth, participants will get to know CBCC and explore issues that parents might raise using role plays, completing activities in the resource, and small group discussions (35 mins). The workshop will end with a brainstorming activity to enable participants to explore practical issues that might arise when delivering the resource to parents (15 mins). Participants will be provided with the Confident Body Confident Child resource and related materials on CD.

Learning Objectives:

  • Describe the research background supporting implementation of Confident Body Confident Child.
  • Deliver an interactive information session about CBCC to parents of young children, using the materials provided and discussed in this workshop.
  • Address questions that parents might raise in an information session facilitated in their own service.

H.
How Do They Do It? Tricks of the Trade in Developing and Managing a Successful Research Group from Leading Researchers in the Field

Emily Pisetsky, PhD, United States; Katie Loth, PhD, MPH, RD, United States; Scott Crow, MD, FAED, United States; Phillipa Hay, PhD, FAED, Australia; Pamela Keel, PhD, FAED, United States; Kelly Klump, PhD, FAED, United States; Ruth Weissman, PhD, FAED, United States

The overall goal of this workshop is to discuss strategies junior investigators can use to create and organize an effective research team and laboratory in a variety of settings. To achieve this aim, we have brought together a panel of senior researchers from different backgrounds, geographic locations, and institutional types, including academic and clinical institutions. During this workshop, we will engage the panelists in a discussion about how they made decisions early on in their career about creating and organizing their research team and laboratory. While there are many different models of successful research teams within the field of eating disorder research, junior investigators are often only exposed to the model provided to them by their own primary mentor. This workshop will provide participants unique insight into the organization and management techniques utilized in the eating disorders research labs of five senior researchers, Drs. Scott Crow, Phillipa Hay, Pam Keel, Kelly Klump, and Ruth Weisman. During the first half of the presentation, workshop leaders Pisetsky and Loth will facilitate a question and answer session among panel members. Each panel member will be asked to discuss specifics about the organization and management of their individual research labs as well as highlight their own successes and challenges in creating and maintaining a productive research group. Topics of discussion will include hiring student volunteers, research assistants and staff, research mentorship, developing strong collaborations within and across institutions, and balancing the generation of research ideas, grant writing and dissemination of findings. Time will be devoted to questions that address each panelist’s broad management philosophy, as well as specific organizational methods. During the second half of the workshop, attendees will have the opportunity to ask panel members questions. The goal of these audience-led questions is to help workshop attendees identify concrete ways they might integrate suggestions from this panel of successful researchers into the creation and management of their own research lab. This workshop is geared toward junior investigators at all stages (graduate students, post-docs, junior faculty, and clinicians planning to develop a line of research).

Learning Objectives:

  • Identify different models for staffing (volunteers, research assistants, staff) within research laboratories as well as the benefits and drawbacks of each model.
  • Describe advice on ways to develop strong research collaborations both within and across institutions.
  • Note different methods senior researchers have utilized to achieve balance between the generation of research ideas, grant writing and dissemination of study findings.

I.
"I Read It On the Internet”: Sorting the Useful from the Useless in Online Research

Millie Plotkin, MS, United States; Carrie Arnold, MA, MPH, United States; Craig Johnson, PhD, FAED, United States

When looking for information about eating disorders, everyone from patients to mental health professionals generally turn to the Internet. Although online information may be plentiful, it can often be challenging to distinguish outdated, inaccurate information from current, peer-reviewed evidence. Misinformation about eating disorders can be life-threatening if it steers a patient or provider in the wrong direction. This presentation will cover the different types of online information and resources about eating disorders and some simple tips and techniques that clinicians can use to evaluate materials they provide to their patients, use for their own education and share with other providers. Strategies for identifying useful and accurate research, patient handouts, blogs, personal stories and more will be covered. Participants will also be taught how to avoid information overload.

Learning Objectives:

  • Recognize factors that indicate the reliability of an online resource for eating disorders information.
  • Evaluate the credibility of resources clinicians can use in psychoeducation for patients and their family members.
  • Identify eating disorders information clearinghouses around the world and understand how to use them in a meaningful way.

J.
Make No Bones About It Effects of Anorexia Nervosa on Bone: An Interactive Session

Madhusmita Misra, MD, MPH, United States; Vibha Singhal, MD, United States; Meghan Slattery, MSc, United States

The purpose of this workshop is to (i) discuss and review available and recent data on the impact of anorexia nervosa (AN) on bone outcomes, as well as possible strategies to treat low bone density, and (ii) to review in an interactive format the best strategies for providers to inform patients about the effects of AN on bone. Anorexia nervosa is known to have deleterious effects on bone density, structure and strength, and our studies have demonstrated a higher prevalence of fractures in young women with AN compared with normal-weight young women (31% vs. 18%). Onset of AN in the adolescent years is particularly worrisome because the teenage years are critical for bone accrual towards attainment of peak bone mass, and deficits incurred at this time are likely to be permanent. It is critical to optimize weight gain and resumption of menses in AN, however, studies suggest that complete catch-up does not always occur despite recovery, possible because this is often partial, or because of relapses. Therefore, investigators have examined other strategies to optimize bone accrual while working towards persistent recovery. The first section of this workshop will include a didactic session by Dr. Misra (20 minutes) that will review current knowledge regarding the impact of AN on bone, factors contributing to low bone density in AN and possible therapeutic strategies. Following 5 minutes for questions and answers, the session will continue with a 15 minute talk by Dr. Singhal, who will discuss how best to discuss the impact of AN on bone with patients. She will discuss strategies to inform patients in very simple terms about the importance of the teenage years for bone accrual, why AN causes low bone density, and the effect of recovery on bone. This session will include role play. After another 5 minutes for questions and answers, the workshop will continue with an interactive 'Jeopardy' like session run by Ms. Slattery (40 minutes) to clarify issues covered in the earlier didactic and to emphasize the key 'take-home' points for providers and patients.

Learning Objectives:

  • Describe the impact of anorexia nervosa on bone.
  • Review possible therapeutic strategies to optimize bone outcomes in anorexia nervosa.
  • Discuss best strategies to discuss effects of anorexia nervosa on bone with patients.

 


Workshop Session II
Friday, April 24, 2015
11:15 a.m. – 12:45 p.m.

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A.
Articulating the Philosophy Underlying Your Treatment Approach

Marion Olmsted, PhD, FAED, Canada; Patricia Colton, MD, MSc, Canada

Most treatment programs have a modus operandi that is, by necessity, not based on empirical data. Decisions are made about what treatments to provide, whether they need to be evidence-based and manual guided, how long treatment will last, what patients are expected to do in order to improve, and what steps to take when patients do not respond to treatment. These decisions reflect an underlying philosophy that it may be useful to articulate clearly and share with clinicians, patients and families. What are the basic elements of a useful treatment philosophy? How can this philosophy most effectively be implemented? How do treatment philosophies evolve over time? The purpose of this workshop is to stimulate thought and discussion regarding the beliefs and philosophies which underlie program policies, clinical decision making, and everyday treatment planning and delivery. Participants will engage actively in exploring the potential benefits and drawbacks to treatment philosophy development and adherence. Participants, with the session leaders, will identify administrative and clinical areas which can potentially be more effectively addressed by adoption of an explicit program philosophy. 

Lesson Plan  

1. Introduction to session, overview of session framework (15 min) - co-presentation MO, PC  
2. Active learning 1: participants write down a sentence describing their treatment philosophy – group leaders collect these, review and highlight different levels of treatment philosophy – discussion and didactic material (25 min)  
3. Active learning 2: participants complete a ‘decisional balance’ about clear articulation of treatment philosophy, share in small groups then in larger group discussion (10 min)  
4. Active learning 3: brainstorming challenges in implementation of treatment philosophy in clinical practice; identify 3-4 and break into small groups for discussion (20 min) based around worksheets that will provide a structure for considering the implicit and explicit principles that underlie a clinical decision  
5. Group synthesis and discussion of small group sessions (20 min)

Learning Objectives:

  • Explore the pros and cons of utilizing an explicit, multi-level treatment philosophy in their clinical work.
  • Identify and discuss application of treatment philosophy to clinical challenges.
  • Develop a framework for creating a coherent treatment philosophy.

B.
Difficult Dialogues in Eating Disorders: Can we use AED Relationships to Learn from our Diversity and Advance our Field even when we Disagree?
Carolyn Becker, PhD, FAED, United States; Laura Collins Lyster-Mensh, MS, United States; Judy Banker, MA, FAED, United States; Kelly Klump, PhD, FAED, United States

As a multidisciplinary organization, the AED benefits from the passion and perspectives of a wide range of individuals in our field. Importantly, members view eating disorders through many different lenses based on various factors including (but not limited to) beliefs about etiology, primary role in our field (e.g., clinician, researcher, scientist-practitioner, patient-carer), and professional background (e.g., physician, psychologist, dietician etc.). Although differing perspectives represent a critical strength for the AED, they also can lead to disagreement and a sense that we are working against one another as opposed to being united towards common goals. The aim of this workshop is to explore strategies for improving our success at managing difficult dialogues and challenging issues. The presenters consist of two pairs of AED members who started at opposite ends of specific and contentious issues. Pair one (Collins & Becker) includes a parent-carer-activist with significant concerns about the sub-field of eating disorders prevention and a researcher who studies prevention of eating disorders. Pair two (Banker & Klump) includes a clinician and researcher who started their conversations on the opposite sides of the research practice gap. Both pairs have since formed strong working and respectful relationships that have allowed them to learn from one another. All presenters believe they have learned from the process of facing their difficult dialogues head on with an AED member from the “opposite side.” Presenters will describe their difficult dialogues, and present case examples and lessons learned from their journeys. Using both didactic and experiential strategies, this workshop aims to help AED members move forward more productively with contentious topics. Although this workshop will use the topics of prevention and the research-practice gap as primary vehicles for discussion, participants will be given the chance to explore other topics as well.

Learning Objectives:

  • Explain how diversity is both a strength and a weakness for the AED.
  • Describe how AED members have managed to use AED relationships to manage contentious issues.
  • Describe the benefits of engaging in dialogue with members who hold different perspectives and positions.

C.
“Treat my Eating Disorder, Then I’ll Get Sober”: What Eating Disorder Specialists Need to know about Integrated Treatment for Patients with Substance Use Disorders

Amy Baker Dennis, PhD, FAED, United States; Tamara Pryor, PhD, MSW, FAED, United States

There is a high prevalence of substance use disorders (SUD) in patients with eating disorders (ED). Approximately 50% of ED patients are abusing alcohol, illicit drugs, prescription medicines, over-the-counter drugs or Internet supplements. However, very few programs in either field have developed comprehensive, evidence-based, integrated programs for this comorbid group. Treatment providers in the SUD field are not routinely trained in evidence-based interventions for ED, and SUD programs rarely provide the complex interventions necessary for ED recovery. Likewise ED specialists are rarely trained in evidence-based treatments for patients with SUD. As a result, patients receive fragmented care, and frequently relapse as they vacillate between these disorders. Research suggests that individuals with co-occurring disorders have a greater chance of recovering from both disorders when they receive integrated treatment from the same practitioner. The purpose of this workshop is to begin cross training ED treatment providers in the treatment of SUD. The workshop will begin with a brief review of the need for integrated treatment. Then we will discuss the prevalence and psychoactive properties of drugs of abuse, the clinical characteristics of individuals with alcohol and drug abuse, and evidence-based models/approaches (both psychological and pharmacological) for the treatment of SUD. We will conclude with a video case presentation of a dually diagnosed male patient and discuss how to formulate a comprehensive treatment plan for the long-term management and relapse prevention of both disorders. (This workshop is sponsored by the ED/SUD SIG)

Learning Objectives:

  • Describe the principle and guidelines for integrated treatment for patients with ED and SUD.
  • Discuss the prevalence of SUD in ED patients and the psychoactive properties of the following substances: alcohol; cannabis; sedative, hypnotic and anxiolytics; simulants; hallucinogens; and opiates as well as several evidence.
  • Formulate a comprehensive treatment plan for the long-term management and relapse prevention of both disorders.

D.
Using Exposure with Response Prevention in CBT for Eating Disorders: Why We Don't, Why We Should and How to Do So
Glenn Waller, DPhil, FAED, United Kingdom

This workshop will address the potential value of exposure with response prevention as part of evidence-based cognitive-behavioural therapy (CBT) for eating disorders, our neglect of this powerful tool, and why so many clinicians avoid using it. Exposure should be used widely when delivering CBT for the eating disorders - addressing changes in eating, monitoring, body image, comorbid anxiety, and more. However, evidence and clinical experience shows that we use exposure far less often than we should.  

Drawing on clinical cases and the wider literature, it will be shown that the avoidance of exposure-based work is commonly attributed to four fears: the patient will be harmed; the patient will disengage; the patient will not like the method; and the patient will sue or complain. However, there is evidence that none of these arguments is supported. Rather, the reasons for avoiding exposure-based methods lie in our own anxiety levels, our own safety behaviours, and our overvalued beliefs about other elements of therapy (e.g., the effectiveness of the working alliance).  

This session will use case material to outline the ways that we can use exposure-based methods to produce emotional, cognitive and behavioural change in our patients. It will also consider how we can train, educate and supervise therapists to become better at delivering this evidence-based technique across the eating disorders. Ironically, this will mean we need to think about how to face and overcome our own anxiety about using this approach.

Learning Objectives:

  • Identify the appropriate uses of exposure with response prevention within CBT for eating disorders.
  • Identify why we fail to use exposure with response prevention when working with the eating disorders.
  • Explain and understand how to modify our own pattern of avoiding the use of exposure with response prevention.

E.
Matters of the Heart:  Eating Disorders and Cardiovascular Health
Edward Tyson, MD, United States; Joel Jahraus, MD, FAED, United States

The heart and vascular system account for significant medical morbidity and mortality in patients with eating disorders.  Malnutrition, metabolic derangements, and excessive demands from exercise, impact the heart and vascular system anatomically and physiologically.  Anatomical changes can range from valvular changes to decreased chamber and muscle size.  Physiological changes include impaired cardiac reserve and output, which can be life-threatening, especially if not recognized early and treated aggressively by physicians and others who are unaware of the risks.  Electrical conduction abnormalities are also common and range from mild to life-threatening.  This presentation will include a review of the impact of these changes as well the impact on the cardiovascular system from exogenous factors such as medications and substances typically used for weight loss in eating disorders.  Appropriate evaluation and management will be reviewed including that for common symptoms including chest pain, shortness of breath, dizziness, and palpitations.  A specific review with EKG interpretation will also be included and targeted toward medical as well as non-medical clinicians.  Case presentations will highlight key clinical points. The session will end with a question and answer session.  A handout will also be provided and will include specific literature references.

Learning Objectives:

  • Predict the various physical changes in the malnourished cardiovascular system.
  • Recognize various EKG changes common in eating disorders.
  • Interpret various symptoms that indicate cardiovascular compromise.

F.
Improving Understanding and Enhancing Skills in the Treatment of People with Severe and Enduring Anorexia Nervosa (SE-AN)

Stephen Touyz, PhD, BSc, FAED, Australia; Phillipa Hay, DPhil, MD, MBBS, FAED, Australia; Daniel Le Grange, PhD, MA, FAED, United States; Hubet Lacey, MD, MPhil, FAED, United Kingdom; Bryony Bamford, DClinPsy, BSc, United Kingdom

The aim of this workshop is to increase the understanding and enhance skills in the treatment of people with severe and enduring anorexia nervosa (SE-AN). The workshop will be informed by the leaders’ experience and expertise with two manualised evidence-based outpatient psychological therapies for SE-AN, modified Cognitive Behaviour Therapy and Specialist Supportive Clinical Management (CBT-SE and SSCM-SE).  The lesson plan will comprise: (i) a 20-minute presentation of the theoretical basis, structure and content of CBT-SE and SSCM-S followed by; (ii) a detailed account and small group discussions over 50 minutes of specific skills that that we have found to be important to treatment success and reduced treatment attrition, including skills specific to either SSCM-SE or CBT-SE and skills that are found in both therapies. The skills that will be presented in part (ii) include forming a therapeutic alliance over a lengthy engagement period with extended motivational interviewing techniques and tailoring therapy to the clients stage of change, promoting autonomy through a collaborative “goal setting” process, utilisation of psycho-education and supportive psychotherapy, addressing interpersonal and social deficits and affect regulation through expansion of self-schema and other techniques, medical safety, and attaining behavioural change with main outcome of an improved quality of life. The final phase of the workshop will be: (iii) a  20-minute panel lead case discussion addressing therapist’s management of  their emotional responses when engaged in therapy for people with SE-AN and when addressing gaps between their and the client's aspirations, with shared experiences of the utilisation of helpful processes such as supervision.  Active learner teacher techniques will include small group role plays facilitated by therapist-client dialogue (small groups will be each lead by a presenter) during part (ii), and a question-and-answer panel lead case discussion during part (iii). Handouts will be provided of therapeutic tools, the case for discussion, as well as background scientific papers.

Learning Objectives:

  • Apply the principals of CBT-SE and SSCM-SE to their clinical practice in the treatment of people with SE-AN.
  • Use specific tools for establishing a treatment alliance and treatment goals in people with SE-AN who are otherwise disengaged with treatment.
  • Conversant  in strategies that enable sustaining a therapeutic  environment that is associated with improved adaptive function in the treatment of people with SE-AN.

G.
Eating Disorders, PTSD and Comorbidity: Integrating Evidence-based Treatment Approaches Using Person’s Case Formulation Approach
Timothy Brewerton, MD, FAED, United States; Claudia Zayfert, PhD, United States

This workshop will benefit clinicians and researchers who want to increase their understanding of the role of trauma and PTSD in the etiology and treatment of eating disorders and improve their ability to manage comorbid problems. Violence and adverse life events are common. Traumatic experiences, particularly those that produce symptoms of posttraumatic stress disorder, are significant yet nonspecific risk factors in the development of EDs with bulimic symptomatology. Traumatized individuals often present with complex clinical presentations with multiple problems, which can present challenges for clinicians aiming to deliver evidence-based treatments. Current treatment manuals offer limited guidance for how to address multiple problems (i.e., EDs, PTSD, anxiety disorders, mood, and substance use disorders) in a systematic manner. Workshop participants will learn to integrate current knowledge of trauma-related comorbid psychopathology into clinical practice and to deliver evidence-based treatment for patients with multiple problems that include PTSD and EDs. The workshop will include review of 1) available research on the etiologic role of trauma in eating disorders; 2) evidence-based treatment approaches for PTSD and other psychopathology; 3) Person’s case formulation approach for designing individualized empirically based treatment plans for patients with complex presentations. Significant time will be devoted to small group practice exercises focused on formulating hypotheses regarding the interaction of comorbid problems and devising evidence-based treatment plans to address multiple problems. The goal is for participants to increase their skills and confidence in managing complex clinical presentations.

Learning Objectives:

  • Describe the role of PTSD and partial PTSD in mediating the effects of psychiatric comorbidity in patients with eating disorders with bulimic features.
  • Describe evidence-based practices relevant for treatment of comorbid PTSD and eating disorders.
  • Design individualized empirically-based treatment plans for patients with complex presentations that include trauma, eating disorders, and other psychopathology using Person’s case formulation approach.

H.
Tackling Stigma Associated with Eating Disorders: A Shared Responsibility
Rachel Bryant-Waugh, DPhil, MSc, BSc, FAED, United Kingdom; Susan Ringwood, BA, FAED, Beat, United Kingdom

Stigma associated with eating disorders remains a significant problem. It affects individuals with an eating disorder as well as family members and others closely involved. The impact of stigma can be profound; causing immense distress, damaging relationships and hampering recovery. Despite a number of high profile campaigns designed to reduce mental health stigma more generally, we know that for eating disorders, there is still a long way to go. The presenters of this workshop have recently been involved in surveying the experiences of sufferers, parents and siblings of those with an eating disorder. This has resulted in a wealth of information from those most affected, to include continued experience of stigmatizing attitudes from mental health professionals, as well as positive, constructive suggestions about how to move forward. This workshop provides an opportunity to share this information, to explore ‘everyday’ eating disorders stigma in depth and to reflect on the implications for potential changes to delegates’ own clinical and professional practice. Stigma and the experience of stigmatizing attitudes is relevant to all conference delegates and the session will include discussion and debate on a range of strategies from small individual or local initiatives to larger scale campaigns.    The relevance of the three well described social approaches to tackling mental health stigma - Protest, Education, Contact – will be applied to eating disorders. The session will commence with an introduction to the subject (15 mins) followed by an exercise designed to help participants reflect on their own role and attitudes (15 mins). Qualitative information will be shared from the surveys (20 mins) leading to active participation by all to create a personal plan for each delegate (20mins). Closing discussion (20 mins) will involve all present with the aim of consolidating awareness of the importance of stigma and enhancing commitment to work towards reducing it.

Learning Objectives:

  • Access an increased awareness of the range of experiences of sufferers, parents and siblings in relation to stigma associated with eating disorders.
  • Reflect on the experiences of others and identify implications for their own clinical and professional practice.
  • Develop a personal plan of action aimed at contributing to reducing stigma.


I.
Intensive Family Treatment (IFT) for Adolescent Eating Disorders: A Brief, Intensive Application of Family-Based Treatment
Stephanie Knatz, PhD, MA, United States; Ivan Eisler, PhD, FAED, United Kingdom; Stuart Murray, DClinPsy, PhD, United States; Roxanne Rockwell, PhD, United States; Kerri Boutelle, PhD, United States; Walter Kaye, MD, FAED, United States

With contemporary evidence continuing to support the efficacy of family-based treatment (FBT) in the treatment of adolescent AN, the clinical and empirical interest in family therapy-based interventions continues to surge. However, whilst FBT currently represents the gold standard treatment for adolescent AN, a large minority of adolescents may not fully remit from symptoms throughout FBT. As such, alternate pathways for the family-assisted resolution of adolescent eating disorders have recently emerged. Our team recently developed a novel Intensive-family therapy (IFT) program for adolescent eating disorders, which represents a unique and time-limited application of family therapy which takes place over the course of one week (40 hours) in a multi-family setting. In keeping with existing family therapy-based approaches, IFT centralizes the role of parents throughout treatment, although blends additional systemic, multi-family therapy, parent-management training, and dialectical behavior therapy practices into an intensified time limited immersion into multi-family-based treatment.   Our preliminary data suggests that IFT is a clinically effective and cost effective treatment for adolescent AN, which possesses unique benefits in comparison to other forms of family therapy-based treatments. In addition, long-term follow-up data suggests comparable rates of sustained symptom remission to the gold standard FBT approach. Further, the localized and intensified nature of IFT means that the scope of evidence-based practice may be extended for those who don’t have ongoing access to specialized clinicians in their geographical region.   Thus, in the context of our highly promising emerging data, we aim to disseminate the clinical content of this unique treatment approach, highlighting an overview of our IFT program, outcome data collected over the last 5 years, and will also share patient and family accounts of IFT.

Learning Objectives:

  • Describe the clinical content of the Intensive Family Treatment Program.
  • Apply treatment strategies related to core theoretical principals of IFT.
  • Summarize the current evidence base for IFT and multi-family therapy for eating disorders.

J.
Bringing Dialectical Behavioral Therapy to the Table: How to Merge Dietetic and Therapeutic Strategies and Skills to Maximize Behavior Change

Maria Teresa Rivera, MS, BS, FAED, United States; Kay Watt, LPC, BA, United States; Loren Prado, LPC, United States

Nutrition therapy is a crucial component in the treatment of eating disorders, and registered dietitians are important members of multidisciplinary teams. Dietitians can be most effective when they integrate the treatment modality of their team with their approach to restore the eating behavior. Such congruence of approach improves the effectiveness of treatment for the patient and improves communication within the team. This presentation provides an example of how one team has effectively integrated dietary and clinical philosophy using Dialectical Behavioral Therapy (DBT) to provide a consistent treatment model. DBT has been recognized as an effective tool to treat patients with borderline personality disorder and is now recognized as a treatment that enhances the effectiveness and positive outcomes of Cognitive Behavior Therapy for Eating Disorders. For the therapist and the dietitian, DBT provides assumptions, strategies and skills that structure treatment. Specifically for the dietitian, the nature of the nutrition interventions requires effective, consistent and quick responses while working with patients with extreme anxiety and emotion dysregulation. DBT provides effective tools for these interventions. Additionally, patients learning new skills during treatment must generalize them in all relevant contexts, particularly at mealtimes. Reinforcement of DBT skills by dietitians aids this important generalization. Illustrating an effective integration model, this workshop provides dietitians and therapists practicing from any modality with insights and tools to apply in their own practice.

Learning Objectives:

  • Recognize the specific role of the dietitian in the promotion of  behavior change while working in a multidisciplinary team.
  • Apply specific DBT strategies, assumptions and skills during meal sessions, nutrition individual counseling, nutrition education and grocery shopping.
  • Identify the DBT strategies, principles, assumptions and skills and the complexity of the nutrition intervention during meal sessions, nutrition counseling and grocery shopping exposure.

 


Workshop Session III
Saturday, April 25, 2015
1:15 – 2:45 p.m.

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A.
Should I Suggest that My Patient Participate in a Research Study? Helping Patients and Clinicians Climb the Steps to the Ivory Tower

Amanda Joelle Brown, PhD, United States; Evelyn Attia, MD, FAED, United States; Lindsay Bodell, MS, United States; Annette Santiago-Espana, PhD, United States

The goal of this workshop is to bring together clinicians and researchers to generate discussion about misconceptions, biases, and challenges that may arise when individuals with eating disorders are considering research participation, as well as opportunities that research may present for patients.  Panelists representing a range of perspectives spanning the research-practice spectrum will discuss issues relevant to their areas of expertise.  Topics addressed in the didactic portion of the workshop will include: determining whether a clinical patient is well enough – or ill enough – to participate in research, prioritizing clinical care while maintaining scientific integrity, navigating the “therapeutic misperception” with patients involved in research, quelling patients’ fears about experimental interventions, assessing and diagnosing patients for research purposes without the ability to offer treatment, and determining the generalizability of data across treatment-seeking and non-treatment-seeking populations.  An interactive, case-based discussion will follow, during which workshop participants will be encouraged to share their perspectives on the challenges of bridging the research-practice gap from both clinical and scientific viewpoints.

Learning Objectives:

  • Generate open, collaborative discussion about misconceptions, biases, and challenges that may arise when engaging individuals with eating disorders in conversations about research participation.
  • Consider strategies for optimizing communication and collaboration across the research-practice spectrum.
  • Appreciate the complexities of conducting clinical research from the perspective of both scientists and practitioners.

B.
Giving Hope to the Hopeless or Exploitation of the Vulnerable? The Ethics of Deep Brain Stimulation Research for Severe Anorexia Nervosa

Rebecca Park, BSc, MBBS, MRCPsych, PhD, United Kingdom; Jacinta Tan, MBBS, MRCPsych, PhD, United Kingdom

Severe Anorexia Nervosa is a major treatment challenge, with some patients continuing to remain severely ill despite all efforts to help them. Patients are therefore often keen to participate in new and potentially promising research treatment trials, and professionals are correspondingly keen to research novel therapies. In particular, neuromodulation strategies such as Deep Brain Stimulation and Transcranial Magnetic Stimulation are now at the stage of early treatment development for severe Anorexia Nervosa.  However, major ethical issues are raised by potentially high risk research with uncertain outcome in this vulnerable patient group, which both clinicians and researchers need to understand. The presenters are eating disorder psychiatrists and clinical researchers with specialist interests in clinical neuroscience and medical ethics respectively. Dr Park is principal investigator on a study into Deep Brain Stimulation for severe Anorexia Nervosa, incorporating an ethics sub-study in collaboration with Dr Tan. Lesson Plan: ‘Background Knowledge Probe’ methods will be used to ascertain participant backgrounds and level of knowledge (5 minutes). Using the ‘Ten Two Strategy’ the presenters will introduce concepts underpinning research ethics (20 minutes). The ‘Think / Pair / Share’ technique will be used to help participants engage with the relevance of research ethics to their own context (15 minutes). ‘Problem-Based Learning’ will use Deep Brain Stimulation research for severe enduring Anorexia Nervosa as a case example to teach participants how to apply the basic principles of research ethics to eating disorders and appreciate the complex issues involved (35 minutes). Finally, participants will practice newly acquired understandings of research ethics principles by applying these to their own contexts using ‘Shared Brainstorming’ (15 minutes).

Learning Objectives:

  • Understand the basic principles of research ethics.
  • Appreciate the challenges of innovative treatment research in severe eating disorders.
  • Describe the ethical issues regarding consent, capacity, vulnerability and voluntariness raised by cutting edge treatment research in individuals with  severe eating disorders.

C.
The GI Primer: What You Need to Know About Laxative Abuse, Constipation, Gastroparesis, Probiotics, Reflux, Celiac Disease and More
Mini Mehra, MD, BS, United States; Linda Schack, MD, BS, United States

Eating disorders patients who are beginning treatment often complain of wanting to eat, but being unable to. When patients with gastrointestinal disorders get the medical care they need, their recovery is faster and more comfortable. This presentation is aimed at physicians and non-physicians alike and will utilize experiential learning techniques to help participants increase their understanding and skill with gastrointestinal disturbances in the eating disordered patient. Topics will include laxative abuse, constipation, gastroparesis, Celiac disease, gastroesophageal reflux, gluten/lactose intolerance, small bowel bacterial overgrowth (SBBO), rumination, and the use of probiotics. Each of these topics will be discussed in terms of how to comfortably and accurately diagnose, or for non-physicians, to understand this process and know when a client should be referred. Best practice treatment plan on each entity will also be discussed with didactic teaching and the participants actively learning by engaging with case reports. Each detailed case study will have the history of a sample patient with labs and x-rays for audience review and discussion to assist practitioners in improving their skills. Constipation and laxative abuse (diagnosis, complications, and treatment) will be the bulk of the presentation and will require approximately 15 minutes each. Case report on gastroparesis will be 10 to 12 minutes. Gastroesophageal reflux disease (GERD), Celiac disease, gluten/lactose intolerance, the use of probiotics, rumination and small bowel bacterial overgrowth (SBBO) will each be discussed for approximately 5 minutes. Further discussion and audience questions will encompass the remainder of the allotted presentation time.

Learning Objectives:

  • Explain the mechanism of gastroesophageal reflux.
  • Describe the evaluation of the patient with suspected gastroparesis.
  • Explain the difference between gluten intolerance and Celiac disease.

D.
Minimising the Risk of Relapse Following Treatment

Christopher Fairburn, MD, FAED, United Kingdom

This workshop will address the subject of relapse following treatment.  The workshop will open with a clinically-oriented account of what is known about the causes of relapse with a distinction being drawn between relapses that occur shortly after treatment and those that occur later on.  Then ways of minimising the risk of relapse will be described in detail.  Particular emphasis will be placed upon the use of two distinct strategies; one being the addressing of all the processes that have been maintaining the person's eating problem, and the other being the development of skills for identifying setbacks early on and tackling them using metacognitive procedures.

Learning Objectives:

  • Classify the causes of relapse into two main types.
  • Formulate strategies and procedures for minimising the risk of relapse in the short-term.
  • Formulate strategies and procedures for minimising the risk of relapse in the longer-term.

E.
Assessment and Treatment of Bariatric Surgery Patients
James Mitchell, MD, FAED, United States; Leslie Heinberg, PhD, FAED, United States; Eva Conceicao, PhD, Portugal

Patients who are candidates for, or who have undergone, bariatric surgery are of increasing interest and importance to eating disorder clinicians.  Interventions with these patients may involve the psychological assessment prior to surgery, counseling in preparation for surgery, and increasingly, aftercare in patients who have experienced the development of or the re-emergence of problematic eating behaviors.  At times these can present as traditional eating disorders but also in other forms including sub-syndromal presentations.  The workshop will be divided into several sections:  1) A brief, didactic overview, detailing the forms of bariatric surgery that are currently being utilized, including their outcomes and complications (10 minutes); 2) Downloaded handouts will then be discussed that include materials that needs to be covered in a bariatric surgery patient evaluation, including weight and diet history, eating patterns and eating pathology, physical activity, general psychopathology, trauma history and prior mental health treatment, as well as an assessment of stressors,  coping skills, and social support. These materials will be reviewed, and an abbreviated role playing interview will be conducted between two of the presenters (30 minutes); 3) The workshop will then focus on therapeutic strategies and techniques that can be utilized either in the preparation for or the after-care of bariatric surgery patients who have had eating problems.  Copies of a draft manual (179 pages) that is now being utilized experimentally will need to be downloaded and brought to the session by participants.  The program is comprehensive and uses cognitive behavioral techniques, with a strong emphasis on regular exercise participation.  The manual will be briefly reviewed, with individual workshop participants completing worksheets included in the manual (40 minutes); 4) At the end of the workshop there will be time for questions and discussion, including brief case presentations from participants who have worked with this patient population (10 minutes).

Learning Objectives:

  • Describe the forms of bariatric surgery that are currently employed.
  • Describe the elements that should be included in the psychosocial assessment of bariatric surgery patients.
  • Describe five treatment elements that can be utilized in the after-care of bariatric surgery patients who develop eating problems.


F.
Global Inclusion Workshop (Partnership Chapter and Affiliate Committee): A Worldwide View on Specific Challenges Eating Disorder Societies Face in Facilitating Treatment for People Suffering from an Eating Disorder

Annemarie van Elburg, MD, PhD, Netherlands; Ursula Bailer, PhD, MD, FAED, United States

The Partnership Chapter and Affiliate Committee (PCAC) is a committee of the AED with goals to link national eating disorder societies. The AED establishes formal collaborations with organizations of eating disorder professionals around the globe who share the AED’s mission of promoting the treatment, research, and prevention of eating disorders. The Partnership, Chapter and Affiliate Committee (formerly Sisterhood, Chapter and Affiliate Committee) was established in 2009 and seeks out suitable Partner Organizations (national multidisciplinary eating disorder organizations) and Affiliate Organizations (organizations of single disciplines or those dedicated to individuals with ED) and helps build mutually beneficial collaborations with and between them. In this workshop we will talk about the role of PCAC in AED and report on the inventory we made (30 min). We will then discuss the main issues that many of us are facing in the delivery of treatment to people with eating disorders:   

1)    Lack in funding and lobbying  
2)    Gap between knowledge from research and application in clinical care  
3)    Treatment modalities and transition from one to the other; access to care

The final portion of the workshop will be destined to draw up a collective statement to be issued to the board of AED and worked out in further detail within the different national societies.

Learning Objectives:

  • Describe the role of PCAC in AED.
  • Interpret the international challenges faced when delivering treatment to people with EDs.
  • Determine their own course of action based on this interpretation.

G.
Healing the Cartesian Split: Management of Adults and Children Admitted to Medical and Pediatric Units with Severe Anorexia Nervosa: The MARSIPAN Guidelines in Practice

Paul Robinson, MD, United Kingdom; Dasha Nicholls, MD, FAED, United Kingdom

Some patients with Anorexia Nervosa (AN) become so unwell that they have to be admitted to somatic inpatient units.  There, they may confuse the staff by engaging in destructive behaviours and their management can be extremely challenging, so much so that the patient may die.  Common problems encountered are 1. The Refeeding Syndrome, due to over-rapid refeeding, 2. The "Underfeeding syndrome", due to the provision of (or the assimilation of) inadequate calories, 3. Covert behaviours such as secret exercising and disposal of food supplements, 4. Recruitment of friends and relatives to help the patient avoid weight gain by, for example, bringing in laxatives.  The MARSIPAN (Management of Really Sick Patients with Anorexia Nervosa) guideline in the UK was writen by a large group of psychiatrists and physicians, consulting with non-medical colleagues and carers, with the aim of providing a usable framework with which to approach the management of this very challenging group of patients.  In the last 4 years, the guideline has gained substantial recognition in eating disorder services, and increasing, though still inadequate, usage in medical units. A guideline for use with patients under 18 (Junior MARSIPAN) has also been produced and has achieved somewhat wider acceptance in the paediatric community.  In this workshop the convenors of the adult MARSIPAN and the Junior MARSIPAN groups will train delegates to 1. Assess risk, 2. Deal with physical complications of  severe malnutrition, 3. Manage the behavioural and family difficulties that can arise in this context, 4. Liaise creatively with medical and paediatric services  in order to empower them in the complex task of treating both physical and mental aspects of this potentially fatal condition.   The workshop is suitable for all front line staff who may encounter a patient with severe AN, including doctors, nurses, dietitians and psychologists in primary care, emergency rooms, other medical services and eating disorder units.

Learning Objectives:

  • Assess risk in a severely ill patient with Anorexia Nervosa.
  • Provide the right amount of nutrition to patients with severe AN and avoid both Refeeding and Underfeeding syndromes.
  • Liaise effectively with medical and paediatric colleagues in order to empower them to work with this challeging client group.

H.
The Run to Nowhere: Compulsive, Driven, Excessive, Obligatory Exercise
Marcia Herrin, EdD, MPH, RD, FAED, United States; Ed Tyson, MD, United States

Exercise that is out of balance is prevalent in eating disorders across diagnoses. Such exercise can lead to a host serious medical complications as well as impede nutritional and physical recovery. Compulsive and/or excessive exercise is also associated with negative emotionality, poor treatment outcomes, and increased risk of relapse. Because exercise is beneficial for physical and emotional health, full recovery is presumed to include safe, enjoyable, and non-triggering physical activity. Few studies have examined exercise as a treatment component and no tested protocols exist for providers on how to manage exercise or on when or how to implement exercise interventions. The workshop will begin with a review of the clinical literature followed by a discussion of the potential negative consequences of exercise and the risks of incorporating and not incorporating exercise in treatment. Workshop speakers, both seasoned clinicians, will provide clinically tested criteria for defining and assessing excessive exercise and strategies for managing exercise in a variety of situations. Also to be reviewed will be when to consider strictly limiting activity, how to address secretive exercise, and how to individualize a definition of “healthy activity.” Case studies will be presented for participants to discuss.

Learning Objectives:

  • Cite the attributes of compulsive, driven, excessive, and obligatory exercise and its consequences.
  • Review the literature on exercise as a component of treatment.
  • Identify treatment strategies used to treat exercise behaviors.

I.
Disseminating Evidence-based Practice Through Effective Communication, Public Engagement and Multi-stakeholder Partnerships: What can we Learn from the Case of the Dove Self Esteem Project?
Phillippa Diedrichs, PhD, United Kingdom; Susan Paxton, PhD, FAED, Australia; Carolyn Black Becker, PhD, FAED, United States; Meaghan Ramsey, BSc, United Kingdom

Great progress has been made in the development and evaluation of effective body image and eating disorder interventions that are now poised for dissemination at scale. Few of us, however, have experience or training in facilitating broad scale dissemination efforts. This workshop will guide researchers, clinicians and advocates to think about how they can facilitate better dissemination of their work by influencing the outcomes of interactions with government, industry, and community and advocacy organisations using strategic communication techniques, public engagement activities and multi-stakeholder partnerships. Presenters will share their experience of working in a partnership between researchers, community organisations and the Dove Self Esteem Project, the social mission agenda for a multi-national company. Specifically, as a case example, they will discuss the practicalities, benefits and challenges of working collaboratively to disseminate evidence-based body image interventions on a global scale through the Dove Self Esteem Project (25 mins). Drawing on her expertise in global marketing, stakeholder management and communications, Ramsey will provide participants with practical strategies they can use to better influence key stakeholders to embrace and build upon evidence-based approaches (15 mins). Participants will then work in small groups to apply select strategies to scenarios that ask them to communicate their research/practice idea to a key stakeholder in their sphere of influence (15 mins). They will then share their work and reflect on best practice strategies in a whole group feedback session (15 mins). The workshop will conclude with an interactive question and answer session, allowing participants to ask questions about how best to use public engagement as a tool to bridge the research-practice gap, with the presenters summarising future directions for the research and practice of dissemination and implementation (20 mins).

Learning Objectives:

  • Identify the potential benefits and challenges of using public engagement and partnership strategies to disseminate and build upon evidence-based programs, research and practice in body image and eating disorders.
  • Apply key communication and stakeholder influencer strategies to use their expertise and research to influence outcomes of interactions with community stakeholders, promote evidence-based practice, and effect broad-scale change.
  • Describe future directions for dissemination and implementation strategies in eating disorders and body image.

J.
Food Scientists: Sensory-Based Exposure for Very Young Children with a Variant of Avoidant/Restrictive Food Intake Disorder
Nancy Zucker, PhD, United States; Virginia Covington, LCSW, United States; Jodi Petry, MS, United States

Young children with severe selective eating may fall under the category of AFRID if their food variety impairs functioning. In this workshop, we describe the rationale, unique considerations, and implementation of a parent-child intervention for AFRID-SE in younger children. First, we present data documenting some unique features of AFRID-SE that warrant attention in intervention design: an exaggerated disgust response and enhanced oral sensitivity. Second, we review research of unique considerations in the implementation of disgust re-conditioning and describe the framework employed by occupational therapists to address oral sensitivities in children. Third, we describe the implementation of Food Scientists, a mindfulness-based parent-child intervention. Food Scientists uses sensory experiments (e.g., observing sensory habituation) and food experiments (e.g. investigating differences in taste based on tongue placement) that manipulate “sensory super-powers” to help dyads learn about the senses, their bodies, and food. By recontextualizing disgust experiences as experimental explorations, the intervention aims to create a fun, curious, context that increases a child’s willingness to try new foods and expand the repertoire of acceptable foods. Efficacy, feasibility, and acceptability data are presented from 30 families.

Learning Objectives:

  • Explain the role of disgust and oral sensitivity in the emergence and maintenance of AFRID-SE.
  • Describe and explain how to address unique issues that arise in the management of AFRID-SE.
  • Teach attendees to implement sensory hierarchies, sensory experiments, and food experiments, core features of Food Scientists.