Clinical Teaching Day Workshops
The next Clinical Teaching Day will take place June 9, 2010 prior to the ICED in Salzburg, Austria.

Clinical Teaching Days are designed for the treatment provider. Sessions are smaller, “how-to” workshops that are designed to increase participants’ knowledge of accepted treatments and expand clinical skills. Participation in the AED Clinical Teaching Day on Wednesday, April 29 requires a
separate registration fee. The 2009 ICED will feature seven Teaching Day sessions.

Clinical Teaching Day 2010
June 9, 2010
Salzburg Congress and Sheraton Salzburg
Salzburg, Austria

A. Collaborative Care: The New Maudsley Model

Janet Treasure PhD, FRCP, FRCPsych, Kings College London, South London and Maudsley Hospital, UK and Pam MacDonald, MSc, Netherlands

The aim of this workshop is to describe a simple intervention developed to help non-expert carers (in particular family members and as a preliminary resource for health professionals at home and professional teachers and counselors) develop the skills and expertise relevant to working with people with eating disorders. Active involvement of the family in treatment and early intervention reduces the need for admission and prevents the illness becoming entrenched and persisting in adulthood. We have developed a programme to share core skills that are helpful in working with people with eating disorders. Psycho-educational materials form the core of the program a set of digital materials in DVD form. The program can be delivered in various forms depending upon the resources available and the severity of the illness. The theoretical underpinning and the practical approaches to this form of information sharing are described in a recently published book.

B. Treatments of Obesity and Binge Eating Disorder: Psychotherapy, Behavioral Therapy, Psychopharmacology and Bariatric
Martina de Zwaan, MD, University of Erlangen, Erlangen, Germany and James E. Mitchell, MD, Neuropsychiatric Research Institute, Fargo, North Dakota, USA

This session will focus on the issue of obesity particularly as it interfaces with the problem of eating disorders. Simple obesity, obesity associated with binge eating behavior and with binge eating disorder, and obesity related to various pharmacological causes will be reviewed. The primary focus of the session will be on the treatment of these conditions. This will include discussion of psychosocial interventions for obesity and binge eating disorder as well as pharmacological interventions including a discussion of the currently available agents as well as various other agents in development. The program will also include an in-depth discussion of bariatric surgery including the indications for bariatric surgery and the implications of pre-existing eating problems and eating disorders on bariatric surgery outcome, and on the management of bariatric surgery patients.

C. Cognitive-behavioral Therapy for Eating Disorders: Core Skills to Help Your Patients Recover
Glenn Waller, DPhil, Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust and Institute of Psychiatry, King’s College London, London, UK; Jane Evans, DClinPsy, Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK and Madeleine Tatham, DClinPsy, Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, London, UK

This session is aimed at those who are familiar with the delivery of treatments for the eating disorders, but who want to enhance their skills in delivering evidence-based cognitive-behavioral therapy (CBT) as part of their therapeutic toolkit. The session will begin with a brief presentation of the evidence base, and how to use it to motivate the patient. We will then proceed to talk about how to proceed from the generic “hot cross bun” formulation (used to explain the sequencing of treatment from the beginning) to an individualized formulation (used to drive the remainder of therapy). The importance of the therapeutic alliance will be considered, with an emphasis on an approach based on “firm empathy.” There will then be consideration of key CBT skills (Socratic questioning, cognitive challenges, exposure, behavioral experiments, surveys, etc.) and how and when to use them. The second part of the workshop will consist of the participants being broken into small groups to practice key skills (Socratic and motivational work; individualized case formulation; exposure and behavioral experiments). All participants will have the chance to practice each of these skills. Wherever possible, participants’ own clinical case material will be used to illustrate principles and as the basis for practical skills development. The final part of the workshop will be spent integrating this material into a ‘scheme’ for therapy and in trouble-shooting individual cases brought by participants, so attendees are encouraged to bring plenty of case material.

D. Medical Complications of Anorexia Nervosa and Bulimia and their Treatment

Philip S. Mehler, MD, Denver Health Medical Center, Denver, CO, USA

This session will cover in great detail all the medical complications associated with anorexia nervosa and bulimia. Attendance at this session is important for any clinician caring for patients with anorexia nervosa or bulimia given the fact that both of these eating disorders are associated with medical complications which directly impact the ability to achieve a successful outcome.

The session will be structured as a comprehensive, albeit salient and practical, body system by body system orderly review of these medical complications with clear delineation of those which are associated with anorexia nervosa versus those associated with bulimia. In addition, an extensive amount of time will be devoted to reviewing the evidence-based therapeutic options for these medical complications. There will also be ample time during the workshop, as well as at the end of it, for worthwhile and interactive discussions.

E.Multidisciplinary Team Working to Facilitate Treatment of Children and Adolescents with Eating Disorders and Their Families

Dasha Nicholls, MBBS, MD, Great Ormond Street Hospital, London, UK; Hilary Davies, Family Therapist, Great Ormond Street Hospital, London, UK

The session will begin with an overview of multidisciplinary teams and their typical constituents when treating young people with eating disorders. Consideration will be given to why multidisciplinary working is so crucial with this patient group, highlighting the risks of “lone working.” Participants will be invited to reflect on their own work context in terms of its strengths and limitations.

The session will then move on to think about the elements that make team working effective, in particular multidisciplinary team meetings, their purpose and how to make them functional. The way that anxiety about young people, and the anxieties that young people and their families bring, are played out through team members will be highlighted, and the concepts of transference and splitting illustrated.

In the last part of the session, hypothetical case scenarios will be used to facilitate discussion of the way that the tensions and pitfalls of multidisciplinary team working contribute to therapeutic work with young people and their families. The presenters will conclude that multiple perspectives and different therapeutic elements are vital to work with this age group, but that treatment success depends on these elements being integrated, and on providing opportunities for differences between team members to be heard and understood.

F. Everybody Has Won and All Must Have Prizes? How to Improve the Treatment of Eating Disorders? (Jeder hat gewonnen, und Alle sollen Preise haben? Wie kann man die Therapie von Essstörungen verbessern?)

Günther Rathner, PhD, Innsbruck Medical University, Innsbruck, Austria; Karin Waldherr, PhD, Ludwig Boltzmann Institute Health Promotion Research, Vienna, Austria

The number of treatment facilities and specifically of private treatment centres for eating disorders (ED) has increased steadily in the last decades. The glossy brochures and homepages promise ”individualized treatment” which is scientifically based: “internationally accepted and approved (evidence-based) treatments” with supplements like canyoning, rafting, adventure therapy etc. by default. However, the difference between promoted and factual treatments causes serious concern not only in German language countries.

All that glitters is not gold! Given the variety and the differing quality the following questions immediately come to one’s mind: What is a state-of-the-science treatment? What are the cornerstones of good treatment for sufferers and carers? Which elements are necessary and sufficient in treatment, which elements are only add-ons, which elements are mainly advertisement, which elements could be potentially harmful? Which treatment approaches fulfill the necessary quality criteria, for instance evidence-base for their effectivity, recognition of sufferers and carers needs and rights, etc.? Is it possible to provide a treatment according to the state-of-the-science in a private practice? Is a special setting necessary for treatment?

Participants will be i) encouraged to a critical evaluation of the factual treatments offered for ED and ii) enabled to distinguish between good and bad approaches according to established criteria. As we are not sure what is the best treatment of ED, as a minimum prerequisite at least bad and harmful treatments of ED still existing in everyday practice should be blamed.

Die Zahl der Therapieangebote, speziell privater Behandlungseinrichtungen, für Essstörungen ist in den letzten Jahrzehnten ständig gestiegen. Die Hochglanzbroschüren und Homepages versprechen „individualisierte Behandlung“ nach wissenschaftlich fundierten Behandlungsmethoden: „international anerkannte (evidenzbasierte) Behandlung“ inklusive ergänzender Angebote wie z.B. Erlebnispädagogik mit Canyoning, Klettergarten, etc. Allerdings ist der Unterschied zwischen der angeblichen und der tatsächlichen Behandlung Anlass zu grosser Sorge.

Es ist nicht alles Gold was glänzt! Angesichts der Vielfalt und der großen Qualitätsunterschiede stellt sich die Frage, wie ein gutes Behandlungsmodell nach dem state-of-the-science aussehen muss: Was sind die Eckpunkte einer guten Therapie für PatientInnen und Angehörige? Was ist aus therapeutischer Sicht notwendig und hinreichend, was nur add-on, was nur Ankündigungspolitik, was sogar schädlich? Welche Behandlungsmethoden erfüllen Qualitätskriterien wie z.B. ausreichende Evidenz für ihre Effektivität, Beachtung der Rechte von PatientInnen und Angehörigen, etc.? Kann ein/e Therapeut/in in freier Praxis eine Behandlung nach dem state-of-the-science anbieten, oder bedarf es eines bestimmten Settings?

Durch die Beantwortung dieser Fragen soll es den TeilnehmerInnen ermöglicht werden, die tatsächliche Behandlung kritisch zu bewerten und anhand etablierter Kriterien zwischen guten und schlechten Behandlungen zu unterscheiden. Wir sind zwar nicht sicher, was die richtige Therapie für Essstörungen ist; ein Minimum ist jedoch die Demaskierung der schlechten und schädlichen Behandlungen, die nach wie vor in der tagtäglichen Praxis vorkommen.

G. Media Training Workshop - Working Effectively with the Media
Kitty Westin, PhD; Theresa Fassihi, PhD

As eating disorder specialists, we are sometimes asked by members of the media to share our expertise about eating disorders, their treatment and prevention.  Media training is critical in a patient centered healthcare system. Although we may feel confident about our knowledge of eating disorders as practitioners, it is also important to know how to participate effectively in an interview with a journalist in order to disseminate accurate and helpful information. 
In our training session, we will show participants how to prepare for an interview and deliver their message clearly.  Skills for working with both print and broadcast media will be introduced. Participants will engage in practice exercises and discuss the process. 
Additional issues, such as ethics and internet media, will also be reviewed.