ICED 2017 Workshops
W 1.1 - Family-Based Treatment: From the Ivory Tower to the Real World, at All Levels of Care
Ellen Astrachan-Fletcher, PhD1, Daniel Le Grange, PhD, FAED2, Erin Accurso, PhD3
1Eating Recovery Center and Insight Behavioral Health Centers, Chicago, Illinois, USA; 2University of California, San Francisco, San Francisco, California, USA; 3University of California, San Francisco, Department of Psychiatry, San Francisco, California, USA
Although Family-Based Treatment (FBT) is an evidence-based psychological/behavioral treatment for adolescent anorexia nervosa, it is not routinely implemented in community-based clinical settings. In an effort to bridge the research-practice gap (ivory tower vs real world), we have begun research seeking to generate knowledge to inform the adaptation, implementation, and sustainment of evidence-based treatments in community practice. This workshop will include the following outline: We will begin our workshop with a welcome, introduction, and a review of some recent research on FBT (10 minutes). We will then discuss our work that led to the “Family-Based Informed Treatment for Anorexia Nervosa: Handbook for Partial Hospital Program/Intensive Outpatient Adolescent Program” and an overview of FBT in higher levels of care (HLOC). This would include why and how we are adapting FBT for HLOC (30 minutes). Next, we plan to hand out a Questionnaire and give participants time to take the questionnaire regarding attitudes and beliefs about FBT (15 minutes). We will then divide participants into groups to discuss the results of the questionnaire (15 minutes). Following the group discussion, presenters discuss potential solutions for the barriers to using FBT in the “real world,” including role playing difficult situations that might intimidate clinicians and interfere with FBT adoption. The workshop will be concluded by a 20 minute questions and answer period.
- Describe the evidence-base supporting FBT for adolescent anorexia nervosa.
- Identify and understand barriers to using FBT in the “real world.”
- Problem-solve solutions to increase adoption and implementation of FBT.
W 1.2 - Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR): Children, Adolescents, and Adults
Jennifer J. Thomas, PhD, FAED1, Kamryn T. Eddy, PhD, FAED1, Kendra R. Becker, PhD1
1Eating Disorders Program, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and Eating Disorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food. ARFID is so new that there is currently no evidence-based treatment for the disorder. We have recently developed and manualized a novel treatment—Cognitive Behavioral Therapy for ARFID (CBT-AR)—that we are testing in a foundation-funded pilot study at Massachusetts General Hospital in Boston. CBT-AR can be offered in an individual or family-supported format and comprises four stages: (1) psychoeducation and regular eating; (2) re-nourishment and treatment planning; (3) addressing maintaining mechanisms (including sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food); and (4) relapse prevention over 20-40 sessions. A case report describing the successful treatment of an 11-year-old girl with CBT-AR is currently in press in the New England Journal of Medicine, and we are actively recruiting CBT-AR trial participants from our ongoing National Institute of Mental Health-funded grant on children and young adults with ARFID entitled “Neurobiological and Behavioral Risk Mechanisms of Youth Avoidant/Restrictive Eating Trajectories” (R01MH108595). Although CBT-AR is still being formally testing for efficacy, we have already achieved promising results in clinical practice, and our workshop will fulfill the critical need of clinicians who are already seeing such patients and as yet have no resources on which to base treatment plans. Our interactive workshop will begin with a brief didactic description of the rationale for and goals of CBT-AR and detailed case examples drawn from a heterogeneous group of children and adults who have benefitted from this treatment (35 mins). We will then use role-plays and experiential exercises (e.g., in-session food exposure for sensory sensitivity, interoceptive exposure for low appetite) to demonstrate CBT-AR techniques across the four stages of this flexible, modular treatment (40 mins). We will leave ample time for questions and discussion at the workshop’s conclusion (15 mins).
- Describe the basic structure, goals, and session format of CBT-AR for children, adolescents, and adults with ARFID.
- Implement the four basic stages of CBT-AR including (1) psychoeducation and regular eating; (2) re-nourishment and treatment planning; (3) addressing maintaining mechanisms in each ARFID domain; and (4) relapse prevention.
- Tailor CBT-AR to a patient’s unique ARFID presentation by implementing optional modules (e.g., food exposure for sensory sensitivity, interoceptive exposure for low appetite, situational exposure for fear of aversive consequences) as needed.
W 1.3 - Thinking Critically about Risk and Causality: Implications for Work with Patients and Families
Michael Levine, PhD, FAED1, Janet Treasure, PhD, FAED2, Anne Becker, MD, MSc, PhD, FAED3, Howard Steiger, PhD, FAED4
1Kenyon College, Gambier, Ohio, USA; 2Kings College, London, United Kingdom; 3Harvard University, Boston, Massachusetts, USA; 4McGill University, Montreal, Canada
It is common in publications, conference presentations, and clinical work with patients and families to hear phrases such as “Now we know that eating disorders (EDs) are ‘biologically-based mental illnesses’” or “Now we know that EDs are not caused by sociocultural influences.” However, examination of the “evidence base” for these contentions reveals a lack of clarity about logical concepts and evidentiary standards for determining causality and risk. This inattention to detail nurtures an imprecision in language that threatens to render meaningless phrases such as “X is an underlying influence in anorexia nervosa” or “Y sets the stage for bulimia nervosa.” This workshop invites treatment professionals, clinical researchers, and advocates for families to consider in depth several perspectives on the nature of scientific “evidence” in “evidence-based” claims about the causes of EDs. Specifically, this workshop integrates work by a U.S. psychiatrist and medical anthropologist who examines social and cultural mediation of body image and eating disturbance; a Canadian clinical psychologist who studies, and applies in his clinical work, how certain individuals carry real biological susceptibilities that are “switched on” by specific environmental triggers; a British psychiatrist who integrates our understanding of aetiology and how this impacts interpersonal relationships into training for patients, friends, and family; and a U.S. experimental psychologist who applies sociocultural models of risk to prevention programming. Thus, the presenters combine theory, empirical findings, and clinical experiences to help participants improve their ability to be accurate and authentic in talking with patients and families about what we know and do not know in regard to causality and risk, while endeavoring to increase self-acceptance, reduce shame and anxiety, and increase hope and motivation for change.
- Define—in conceptual and methodological terms—and thus distinguish between, a correlate, a risk factor, a protective factor, and a causal (risk) factor for eating disorders
- List three specific ways in which what we know about genetics and brain science can be translated into plain language that will improve work with patients and families in the treatment of anorexia nervosa.
- List two important reasons why standard approaches to thinking about and studying risk factors have limitations
W 1.4 - Implementing the ‘Happy Being Me’ body image intervention programme: Learning from United Kingdom and Australian experiences
Susan Paxton, PhD1, Siân McLean, PhD1, Catherine Stewart, DClinPsy2, Elizabeth Goddard, PhD2, Mima Simic, MSc2, Gill Allen, MA2
1La Trobe University, Melbourne, Australia; 2South London and Maudsley NHS Foundation Trust, London, United Kingdom
Schools are ideal settings for body dissatisfaction prevention; however, dissemination is limited by lack of opportunities for training in evidence-based approaches. This workshop will provide practical training in delivery of the Happy Being Me (Dunstan, Paxton & McLean, 2016) body image programme. The workshop will first review empirical support for the intervention including previous research trials of Happy Being Me in Australia and the UK, and a recent implementation in UK schools by a clinical service to whole classes of 11-12 year old girls and boys (N=150). Preliminary analysis reveals significant changes in body satisfaction, appearance comparison and self-esteem (p ≤ 0.001). The workshop will use an interactive format to involve participants in experiential learning to become competent presenters of body image interventions addressing: peer environments and appearance conversations, media pressure to conform to appearance ideals, engagement with social media, internalisation of appearance ideals, and body comparison. Participants will participate in guided small group role plays of key intervention activities, and engage in collaborative learning to experience media literacy and dissonance approaches to attitude and behavioural change. Program materials will be made available to participants. The workshop will conclude with a discussion of challenges in implementation and dissemination of school-based prevention, including: timetabling; required expertise, training of school based professionals, and alignment of positive body image approaches with curriculum and policies regarding obesity prevention, mental health, and social media engagement. The workshop structure will be as follows: Review of evidence (15 minutes); Role plays (20 minutes); Engagement in media literacy (20 minutes); Exploring social media engagement and effects on body dissatisfaction through representative profile pictures (20 minutes); Challenges of program implementation (15 minutes).
- Apply skills to implement key intervention activities in small group formats
- Apply media literacy strategies to deconstruct traditional and social media messages to reduce persuasive influence of media and social media-based peer interactions
- Identify challenges and implement strategies to overcome barriers to school-based body image intervention delivery
W 1.5 - Medical Complications of Severe Malnutrition
Margherita Mascolo, MD1, Philip Mehler, MD1
1ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA
This workshop will focus on the common medical complications of severe malnutrition and their management, is based on the expertise developed at the ACUTE Center for Eating Disorders at Denver Health. It will include complications special to anorexia nervosa restrictive subtype, binge-purge subtype as well as complications common to both. This is a case-based interactive presentation in which 9 cases are discussed. The cases will focus on common complications of malnutrition and offer practical guidelines for their evaluation and management. There are two cases specific to binge-purge subtype of anorexia nervosa and the remaining 7 are based on complications common to both subtypes. Each case will last about 4 minutes with additional time for questions. Discussion is based on a combination of expertise gained over years of caring for severely malnourished patients as well as based on scientific data and literature review. Case 1: Vital sign abnormalities: bradycardia, hypotension, and hypothermia. When to worry? Case 2: Hepatitis: What’s the work up? What is the mechanism? Case 3: Pancytopenia: Do we need a bone marrow biopsy? What’s the mechanism? Case 4: Hypoglycemia: How do we treat it? Case 5: Osteoporosis: What do we recommend to these young patients? Is treatment different for males and females? Case 6: Refeeding syndrome: With focus on hypophosphatemia and edema Case 7: Gastroparesis: Who is at risk? Do we need radiology studies to diagnose? How do we treat? Case 8: PseudoBartter syndrome seen in bulimia nervosa and binge-purge anorexia: What does it mean? Why do patients become edematous? Can edema be prevented? How can we treat it? Case 9: Purging, diuretic and laxative abuse: how do we detox patients? What long term sequelae can patients have? Do we taper abused laxatives and diuretics? How do we deal with the ensuing electrolyte abnormalities?
- Identify the most common medical complications of severe malnutrition due to anorexia nervosa and bulimia nervosa.
- Understand evidence-based management of severely malnourished patients.
- Recognize criteria for admission to the hospital for treatment of severe malnutrition.
W 1.6 - International Perspectives on Nutrition Counseling
Marcia Herrin, EdD, MPH, RD, FAED,1Shane Jeffrey, BSc, Grad Dip Nut & Diet, APD 2, Hala Abu Taha, BSc, Dietitian 1 3, Asha Mootoosamy, BSc, SRD 4
American Center for Psychiatry and Neurology, Abu Dhabi, UAE; 4Vivre Care Ltd, Hatfield, UK
Nutritional rehabilitation is a key element in the treatment of eating disorders. In most inpatient and outpatient settings throughout the world, dietitians provide the clinical management necessary to correct abnormal nutritional status and dietary patterns that characterize eating disorders. Yet, standards for nutrition practice have not been established. This workshop will be a step toward developing consensus-based standards. Workshop leaders will summarize the nutrition guidelines and standard practices from across the world and present the results of in-depth interviews with some of the world's most experienced dietitians. The workshop will conclude with participants having the opportunity to participate in a Nominal Group Technique to reach consensus on best nutrition practices. Lesson Plan: Introduction of speakers and topic (10 minutes); Survey audience (10 minutes); Content (40 minutes); Nominal Group Technique (20 minutes); Concluding remarks (10 minutes).
- Describe the difference in guidelines and practices in nutrition settings across the world.
- Identify best nutrition practices and discuss implications for various treatment settings.
- Integrate three advanced nutrition counseling techniques into their practice.
W 1.7 - One Size Does not Fit All: How Moderators and Follow-up Data from Randomized Controlled Trials can Inform Integrative Treatments and Matching Interventions to Patients Beyond Eating Disorder Symptoms
Heather Thompson-Brenner, PhD1, Stephan Zipfel, MD2, Susanne Lunn, MSc3, Eytan Bachar, PhD4, Dana Satir, PhD5
1Boston University, Cambridge, Massachusetts, USA; 2University Medical Hospital Tuebingen, Tuebingen, Germany; 3University of Copenhagen, Copenhagen, Denmark; 4Hadassah University Medical Center, Jerusalem, Israel; 5University of Denver, Boulder, Colorado, USA
Ongoing research efforts to improve existing treatment outcomes for EDs often assume homogeneity within groups, in spite of empirical efforts suggesting high rates of diagnostic cross-over as well as significant within group variability in personality and overall functioning. While several randomized controlled trials have compared the relative efficacy of psychodynamic and cognitive behavioral approaches in particular, recent analyses of moderators and follow-up data inform matching treatment approaches to patients beyond manifest ED symptoms and integrating behavioral with affective and relationally focused interventions to promote long-term positive outcomes. The purpose of this workshop is to bring together three prominent clinical research groups from across the world to lead an interactive discussion and answer the following key questions: 1) what particular treatments help specific ED patients subgroups improve and maintain progress; 2) how do the research data, including moderator and follow-up analyses, inform mechanisms of change; 3) and ultimately how can clinicians integrate different theories and tailor interventions at various stages of treatment. We will first present an overview of major theoretical accounts of EDs in the treatment of adult AN and BN. Next, panelists will discuss treatment outcome research and recent data analyses from three separate clinical trials, including predictors of outcome in psychodynamic psychotherapy (PPT), CBT, and nutritional counseling from a mixed community sample of recently hospitalized patients; moderators of drop-out in CBT and PPT for BN; and long-term outcome of CBT, TAU and PPT for AN. Panelists will demonstrate treatment techniques, therapy process and approaches to the assessment of key areas of functioning in EDs and related symptoms. The latest findings in ED research and their direct clinical applications will be reflected in a group process that informs what works best for the individual patient.
- Describe current theories and their evidence bases in the treatment of adult AN and BN
- Identify moderators of treatment outcome and predictors of follow-up in EDs for CBT, PPT, and TAU
- Assess specific interventions by patient subtype
W 1.8 - A Triple Perspective on Barriers to Eating Disorder Treatment
Mark Warren, MD, MPH, FAED1, Leah Dean, BA, Other2, Mirjam Roelink, BS, MS3
1The Emily Program – Ohio, (formerly Cleveland Center for Eating Disorders), Cleveland, Ohio, USA; 2F.E.A.S.T. (Families Empowered and Supporting Treatment of Eating Disorders), Milwaukee, Wisconsin, USA; 3Recovery Warriers L.L.C., Amsterdam, Netherlands
Three members of the Patient-Carer Committee - a clinician, a former patient, and a parent - will offer unique, multi-perspective insights into (perceived) barriers to treatment, in order to spark a dialogue on efforts to improve patient care, strengthen family and community support services, and empower parents to be effective and engaged caregivers. Each presenter will be given equal time and will draw upon personal experience as well as the reported experiences of peers. Barriers presented from the clinician perspective include the lack of access to a full clinical team - especially well trained medical providers, the lack of access to a full range of care services, the tenuous and often misunderstood relationship between research results and clinical results, inadequate treatment options to support connection, commitment and motivation for patients/families, and the need for better quality evidence based treatments overall. Barriers from the patient perspective will focus on internal factors such as anosognosia, stigma, shame, negative attitudes towards seeking help, complex fears, and the walls of resistance that must be broken down in order to allow for recovery. Barriers presented from the parent perspective will focus on external factors, and include compromised standards of medical care, financial limitations, legal complications, lack of communication between treatment team professionals, and the marginalization, blaming and disempowerment of parents. Each presenter will offer solutions for how to identify and address barriers to treatment that pose potential harm to patients and families, and which can derail the best efforts of clinical care. Workshop participants will be able to relate to the barriers presented through a personal and experiential narrative that is authentic, genuine, and heartfelt; and, will better empathize with the frustrations these barriers cause for patients and carers.
- Recognize the importance of including multiple perspectives in formulating a treatment plan, and learn to listen to clinician, patient and carer experiences, observations and concerns in a manner that illuminates the specific barriers that are preventing
- Identify universal and pervasive barriers to effective treatment and integrate into their practices strategies for facilitating better workarounds that strengthen the patient/parent/clinician relationship and maximize the potential for recovery.
- Advocate for improvements to early identification and first interventions, educate others in order to reduce shame, stigma and to debunk myths, provide accessible information about eating disorders that improve public understanding and promote evidence-based treatment.
W 1.9 - Transforming treatments for child and adolescent eating disorders by investing in early intervention and rapid access to specialist community based services
Ivan Eisler, CPsychol, PhD, FAED1, Rachel Bryant-Waugh, BSc, DPhil, MSc, FAED2, Annemarie van Elburg, MD, PhD, FAED3, Sloane Madden, BA, MBBS, PhD, Other, FAED4, Leora Pinhas, MD, MSc, Other5, Dasha Nicholls, MBBS, MRCPsych, Other, FAED2, Mima Simic, MD, MRCPsych, MSc1
1South London and Maudsley NHS Foundation Trust, UK, London, United Kingdom; 2Great Ormond St Hospital NHS Foundation Trust, London, UK, London, United Kingdom; 3Rintveld Center for Eating Disorders, Netherlands, Bilthoven, Netherlands; 4Sydney Children's Hospital Network, Sydney, Australia; 5Eating Disorder Unit, Ontario Shores Centre for Mental Health Sciences, Canada, Toronto, Canada
In recent years significant progress has been made in developing effective treatments for ED with a degree of consensus as to what works. Nevertheless, disseminating effective treatments has been slow and for those suffering from ED, finding access to expertly delivered evidence-based treatments is often difficult particularly early on in the course of the illness when the chances of rapid recovery are highest. In December 2014, the UK Government decided address this problem by investing £150m over 5 years to transform services in England for children and adolescents with ED. A specific aim of this investment was to provide easy and rapid access from primary care to specialist community based multidisciplinary services to ensure early, effective treatment is available to all, regardless of the severity of their illness. We will describe some of the factors that led the Government to allocate this funding at a time when other health service budgets were being cut and the way this pledge is being implemented across England. We will present new health-economic data from the London Care Pathways study which had a key role in convincing the UK Government that investing in specialist community based child and adolescent ED services would not only improve clinical outcomes by providing access to expert evidence-based treatments but would also achieve significant cost savings. The major part of the workshop will be to explore the potential applicability of this type of service model in different health service contexts and the range of opportunities, strengths as well as potential pitfalls that large funding initiatives of this kind may bring. Discussants from several countries with different health service contexts will work with the workshop participants to consider a) the range of service provisions for eating disorders available in their country b) how treatment is funded and the opportunities and constraints this provides and c) the extent to which the service model being developed across England might be applicable to their own health service context and how it would need to be modified. Workshop structure: London Care Pathways study – 10 min Access and waiting times transformation plans in England – 20 min Brief comments by discussants – 10 min Discussion in small groups – 30 min General discussion – 20 min
- Following the workshop participants will be able to describe key features of specialist and non-specialist care pathways of child and adolescent eating disorders
- Following the workshop participants be able to demonstrate the cost effectiveness of different service models for treating child and adolescent eating disorders
- Following the workshop participants will be able to evaluate the strengths and weaknesses of different service level approaches to the treatment of child and adolescent eating disorders
W 1.10 - Becoming a Leader: What Does it Mean for Us and Our Field?
Dianne Neumark-Sztainer, MPH, PhD, RD, FAED1, Debra Franko, PhD, FAED2
1University of Minnesota, Minneapolis, Minnesota, USA; 2Northeastern University, Boston, Massachusetts, USA
As we move forward in our careers within the field of eating disorders, many of us will be asked, or will choose, to move into administrative and leadership positions. The choice provides us with dilemmas and opportunities at both the individual level and in the work we do in our field. In administrative positions, we may have less time to work as clinicians or researchers, after many years of gaining skills in these areas. We may have less time to devote to the field of eating disorders within our specific areas of expertise. On the other hand, these positions offer us opportunities to have an influence in a different manner as we determine agendas, create budgets, and work toward changes in our work environments. Recently, we (i.e., the workshop leaders) have taken on large administrative/leadership roles within our academic institutions and are dealing with new kinds of challenges. The focus of this workshop will be on sharing our experiences – the good, the hard, and the ugly! The format of the workshop will include 15-minute presentations by both of us about our own journeys and experiences, highlighting our trajectories and decision-making processes. This will be followed by an hour of interactive activities and discussion. We will teach leadership skills that participants can take with them to use as they transition over the course of their careers. Hands-on activities focusing on creating teams, understanding power and influence, and identifying strengths will provide a toolkit for participants that can be called upon as they move into leadership roles of any type (research, clinical, or administrative leadership). Small group work, brief assessments, and role play will be used to enhance active learning. We also will promote a discussion among others in the audience who have either moved into administrative or other leadership roles - or are thinking about doing so. Come ready to share!
- Describe factors to be considered in making the choice to transition to leadership positions.
- Learn tools to be better leaders, including, but not limited to, leading better teams, dealing with conflicts, and making decisions.
- Discover strategies for advancing the field of eating disorders from within leadership positions.
W 1.11 - The primary prevention programs Healthy and Free and Zippy´s friends: International collaboration and Czech Reform of Psychiatry.
Jana Gricova, MA1,2, Marketa Cermakova, MA2, and Hana Papezova, MD, PhD1
1Eating Disorders Centre, Department of Psychiatry First Faculty of Medicine Charles University in Prague, Czech Republic; 2Prague Center for Social Services, Prague Primary Prevention Centre, Czech Republic
The authors will present the modality of health promotion and primary prevention (universal, selective, indicated) in the Czech Republic and its development on the background of international European collaboration and Czech Reform of Psychiatry. The reform activities comprise prevention and de-stigmatization in eating disorders and other mental illness. Andreassen et al. demonstrated in 2007 that 71 % internet users of European Union (e.g. 44 % of total population) look for health information on the internet. In 2011-2014, we started with 7 EU countries an international prevention project ProYouth targeting adolescent population older than 15 years (coordinated by Univerzity in Heidelberg) based on results of 3 months programs Essprit a YoungEssprit (Moessner et al., 2008; Bauer et al., 2009, Lindenberg et al., 2011) with significant impact on decrease of onset of clinical cases (5, 9% vs. controls (10, 4%). During 2 years Czech program, we had 10 000 unique website visitors, 1300 screenings, 600 registrations and 243 active participants and 30 chat users. But similarly to other countries only 1% of all visitors left any content on website. And 18 % of visitors were already treated for eating disorders. Participants mostly valued the information, anonymous professional support but disliked the registration and monitoring. The ongoing internet program Healthy and Free reached already 7700 unique visitors in 18 months. And the health promotion program Zippy´s friends targets coping strategies improvement in first grade students of 5-7 years in Czech schools. We demonstrate pre-post test results of the controlled randomized study of exposed students (N=466) and controls (N= 341) and discuss the prevention modalities and methods (age of target population, rate of primary prevention and health promotion, commercial influence on prevention) to be supported in the future.
- To increase familiarity with new technology programs and their impact on different age population.
- To contribute to better understanding of the complex interplay of the cultural and economic issues in culture bounded prevention.
- To discuss directions to plan the methods of new interventions.
W 2.1 - Assessment of Avoidant/Restrictive Food Intake Disorder across the Lifespan: Join the PARDI!
Rachel Bryant-Waugh, DPhil, FAED1, Jennifer J. Thomas, PhD, FAED2, Nadia Micali, MD, PhD, FAED3, Lucy Cooke, PhD1, Kamryn T. Eddy, PhD, FAED2
1Feeding Disorders Team, Great Ormond Street Hospital/University College London, London, United Kingdom; 2Eating Disorders Program, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA; 3Icahn School of Medicine at Mount Sinai/University College London, New York, New York, USA
Avoidant/restrictive food intake disorder (ARFID) was added to a combined DSM-5 Feeding and Eating Disorders chapter in 2013. Given the similarity between ARFID and other restrictive-type eating disorders, as well as the heterogeneity within the ARFID diagnosis (i.e., food avoidance due to sensory sensitivity, lack of interest in eating, and/or fear of aversive consequences), comprehensive multi-disciplinary assessment is critical to effective treatment planning. This workshop aims to: 1. Illustrate key diagnostic features of these common ARFID presentations and their variability across the age ranges (early and late childhood, adolescence and adulthood), 2. Highlight differential diagnoses, relevant psychiatric and medical comorbidities and potential diagnostic pitfalls, 3. Describe a new structured clinical assessment tool: The Pica, ARFID, and Rumination Disorder Interview (PARDI) recently developed by our team to assess ARFID. An international multi-site study evaluating the reliability and validity of the measure is currently underway. In this interactive workshop, we will use a range of methods and participatory activities: 30 minutes of the workshop will be didactic, with the remainder dedicated to participatory activities. Dr. Bryant-Waugh and Dr. Cooke will illustrate ARFID presentations, and explore heterogeneity within ARFID (15 min); delegates will be asked to work in pairs on clinical scenarios focusing on ARFID heterogeneity across ages (15 min). Dr. Micali and Dr. Eddy will describe differential diagnoses with other medical and psychiatric disorders (15 mins). Clinical vignettes will then be provided to the audience to allow an interactive discussion of each case and differential diagnoses in small groups (30 min). Dr. Thomas will introduce the rationale and structure of the PARDI and facilitate a group discussion about key diagnostic features identified by delegates (15 mins). The final 15 minutes will be reserved for audience questions and discussion.
- Describe the complexities of diagnosing ARFID across the lifespan, including differential diagnosis and diagnostic heterogeneity.
- Appreciate the importance of a multidisciplinary assessment to evaluate the three most common ARFID presentations, including food avoidance due to sensory sensitivity, lack of interest in eating, and fear of aversive consequences.
- Apply questions and concepts from the Pica, ARFID, and Rumination Disorder (PARDI) to facilitate evaluation of ARFID in real-world clinical practice.
W 2.2 - An Explanation and Exploration of the Academy for Eating Disorders' "Purple Book" - "Eating Disorders: A Guide to Medical Care."
Suzanne Dooley-Hash, MD1, Debra Katzman, MD2, Beth McGilley, PhD3
1The Center for Eating Disorders, Ann Arbor, Michigan, USA; 2The Hospital for Sick Children, Toronto, Canada; 3P.A.T.H. Clinic, Wichita, Kansas, USA
Eating disorders (EDs) are serious mental illnesses with the potential for life-threatening medical and psychiatric morbidity and high rates of mortality. Yet EDs often go unidentified and untreated by the medical community. In 2007, members of the Academy for Eating Disorders (AED) identified this global deficit related to the understanding, diagnosis and treatment of EDs among the medical community and formed the Medical Care Standards Task Force (MCSTF). This multidisciplinary, international group of experts was charged with developing a method for delivering reliable and useful information to the medical community about ED diagnosis, detection and medical complications. The 1st Edition of the guidelines, “the Purple Book,” was published in 2010 and quickly followed by an updated 2nd edition. Over the next few years thousands of these brochures have been distributed worldwide and translated into several different languages, providing an invaluable resource for medical providers and impacting the care of EDs globally. In 2014, the MCSTF became a permanent AED committee, renamed as the Medical Care Standards Committee (MCSC). The MCSC has since reviewed and updated evidence pertaining to the medical care of patients with EDs across the lifespan, creating a more comprehensive, evidence-based 3rd Edition of the guidelines, entitled “Eating Disorders: A Guide to Medical Care.” This workshop, presented by members of the MCSC, will review the evidence behind the updated guidelines, and discuss creative means for global dissemination. Participants' questions, feedback and suggestions for future editions will be encouraged. Please come to this session prepared to engage in a lively discussion aimed at improving the care of patients with EDs throughout the world.
- Recognize the knowledge deficits prevalent in the community at large regarding the diagnosis, treatment and medical management of eating disorders.
- Understand the recommendations regarding medical care of patients with eating disorders as they are presented in the Academy for Eating Disorders’ “Eating Disorders: A Guide to Medical Care.”
- Identify appropriate targets for global distribution of these guidelines and describe the different ways this resource can be used.
W 2.3 - Shifting Treatment Landscapes: Difficult Dialogues between Academic & Residential Eating Disorder Treatment Providers
Stephanie Zerwas, PhD1, Jillian Lampert, MPH, PhD, RD, Other, FAED2, Eric Van Furth, PhD3
1University of North Carolina at Chapel Hill, Center of Excellence for Eating Disorders, Chapel Hill, North Carolina, USA; 2The Emily Program Foundation, Maplewood, Minnesota, USA; 3Rivierduinen Eating Disorders Leiden University Medical Center, Leiden, Netherlands
The landscape of eating disorder treatment has changed dramatically over the past 10 years in the United States. Free standing treatment centers providing one or more higher levels of care (inpatient, residential, PHP) have expanded rapidly. These programs have also consolidated and attracted significant external financial investment. In the face of this changing landscape, academic medical center programs have declined in size and scope and a number of prominent clinicians have left academia. Thus, the long-standing tension between academic and free-standing treatment centers in the US has intensified. In this workshop, Drs. Lampert, Zerwas, and Van Furth will debate the roles of academic and private treatment. They will also address whether the economics of the health care system drive clinical decision making in US and European models. Key issues will include: 1) Which patients? How do we decide who needs what care? 2) Cost and Coverage: How and why do families pay when insurance doesn’t cover care? 4) Length of stay: avoiding a revolving door or profiting off of long stays? 5) Swag and trips: Do these affect clinical decision-making? 6) Family: Inclusion in treatment or respite? 7) Evidence: What works and what doesn’t work and for whom? Tensions between varying models of treatment often go un-discussed or unacknowledged openly. However, much of our real-world clinical decision making is dedicated to the 40-60% of patients for whom first-line treatments are ineffective. Workshop participants (e.g. clinicians from academic, private practice, and residential treatment centers) will be encouraged to take sides in this debate and represent their opinion in group discussion. International participants will be encouraged to provide their perspective on the impact of their own health care system for treatment. In sum, we believe that all treatment providers share the same ultimate values and goals. We are passionate about helping our patients survive their eating disorders and experience a lasting and strong recovery. Through dialogue, we can find a path forward for the field.
- Describe the tensions between academic and residential treatment centers
- Compare and contrast the decisions that academic and residential providers make when selecting the goals for higher levels of care.
- Synthesize academic and residential clinicians' shared values and generate ideas for future collaboration across varying models of treatment.
W 2.4 - Adjuncts to FBT: DBT, ASD and Perfectionism
Kim Hurst, PhD1, Colleen Alford, Other2, Annaleise Robertson, DClinPsy3
1Griffith University, Gold Coast, Australia; 2University of New South Wales, Sydney, Australia; 3The University of Sydney, Sydney, Australia
While Family Based Therapy (FBT) remains the first line treatment for of adolescent Anorexia Nervosa, research shows a significant minority of patients do not respond or experience only a partial remission by 12 month follow up. A new direction in treatment has been the development of therapy adjuncts that are hypothesised to increase treatment effectiveness while adhering to core FBT concepts. The exploration of what to include in these adjuncts and at what point to introduce them into treatment are in the early stages of clinical research. Three different adjuncts are currently being trialled in Australia which were developed in response to common clinical presentations and comorbidities. These include: · A 7 session DBT based family adjunct which utilises central concepts from DBT to address high levels of distress, avoidance of conflict or emotional expression and high risk behaviours like self-harm or suicide attempts · A 4 session Autism Spectrum Disorder (ASD) based adjunct that can be delivered in family sessions or as a parent group targeting communication, containment and refeeding practices sensitive to ASD · 9 CBT sessions targeting perfectionistic thinking aims to assist adolescents to adjust extremely high, unrelenting standards and be less critical around mistakes This workshop provides a brief overview of the mediators and moderators in FBT, highlighting the ways in which adjuncts have begun to be used to improve treatment efficacy. It is then divided up into 3 sections focusing on: DBT, ASD and Perfectionism. Each section will include a description of theoretical and practical suggestions around how and when each adjunct can be utilised. A case study, role play and video will allow participants to practice and integrate these ideas into their own clinical work, regardless of setting. Introduction: 10 minutes Small group discussion: when to use adjuncts: 10 minutes DBT adjunct overview: 10 minutes DBT adjunct related skill/case study: 10 minutes ASD adjunct overview: 10 minutes ASD adjunct: roleplay of discussing foundational parent skills and attachment needs in an ASD-sensitive way: 10 minutes Perfectionism adjunct overview: 10minutes Perfectionism adjunct related session video clip: 10 minutes Group questions and discussion: 10 minutes
- Determine what adjunct is required and when to best implement this for patients
- Outline the content of three adjuncts that have been trialled so far in Australia – DBT, ASD, and Perfectionism
- Assess how the core concepts of these adjuncts can be implemented in their clinical practice
W 2.5 - Exposure-based treatment for comorbid anxiety: Terrified patients and nervous clinicians
Glenn Waller, BA, DPhil, Other, FAED1, Carolyn Becker, BA, MS, PhD, FAED2
1University of Sheffield, Sheffield, United Kingdom; 2Trinity University, San Antonio, Texas, USA
Eating disorders and anxiety-based disorders (including PTSD and OCD) commonly co-occur. Successful treatment of an eating disorder sometimes yields concurrent remission of comorbid anxiety, but not for all patients. In these cases, it is beneficial for eating disorder therapists to be well armed to treat anxiety directly. Although exposure therapy is widely recognized at one of the most effective strategies for reducing pathological anxiety, remarkably few clinicians utilize this technique. Exposure can be delivered in everyday practice; yet it often is delivered in ways that omit key elements, with a resulting loss of effectiveness. One reason commonly given for this omission is the clinician’s fear of distressing the patient. This workshop will detail the rationale for using exposure for comorbid anxiety – how it works, and why it depends on both the patient and the therapist tolerating their own anxiety and overcoming their joint safety behaviours. Case examples will be used to illustrate how to introduce, deliver and build on exposure in real-life settings, so that we can treat comorbid anxiety with maximum effectiveness.
- Describe key steps in implementing exposure for comorbid anxiety
- Identify patients' safety behaviors
- Identify clinicians' safety behaviors and how they interact with those of patients
W 2.6 - Cultural and National differences in presentation of Eating Disorders (Partner, Chapter and Affiliate Committee Workshop)
Sebastian Soneira, MD, Other1, Ashish Kumar, MD, Other2
1Nutrition Institute of Buenos Aires, Capital Federal, Argentina; 2Alder Hey Children’s Foundation NHS Trust, Liverpool, United Kingdom
Eating habits, the social value of food, and idealized body shape are contextualized and vary across cultures. While globalization has spread Western values regarding food and eating traditions across many societies, there are still important differences and conceptions of the social and cultural role of food. Additionally, the ideal body image is modulated by cultural influences. As a result, presentation of Eating Disorders can vary according to the social context.The objective of this workshop is to address the different influences on and presentations of eating disorders across cultural contexts.Speakers from different parts of the world will describe the situation in each country using the same questions as guidelines so the same aspects can be compared for each country. Then we will proceed to discuss the topic with the audience in order to establish similarities and differences of eating disorders in different countries.
- To define the different clinical aspects of Eating Disorders in each country and how this aspects are influenced by culture.
- To exchange information with the audience about the socio- cultural influences on eating disorders and how it may shape the presentation of Eating Disorders symptoms in each country
- To establish similarities and differences on the issues presented and assess whether there is a need to design treatment strategies adapted to each society
W 2.7 - Shifting away from DSM diagnostic labels and towards dimensional phenotypes: Will this make research more clinically useful or widen the research-practice gap? Let’s talk about it.
Theresa Fassihi, PhD1, Ann Haynos, PhD2, Ursula Bailer, MD, FAED3, Janet Treasure, Other, FAED4, Scott Moseman, MD5
1Private Practice Clinician, Houston, Texas, USA; 2University of Minnesota Medical Center, Minneapolis, Minnesota, USA; 3Medical University of Vienna, Vienna, Austria; 4Kings College London Institute of Psychiatry, London, United Kingdom; 5Saint Francis Hospital, Tulsa, Oklahoma, USA
New trends in research are moving away from the use of diagnostic classification systems and towards the study of brain systems and behavioral phenotypes. This change is being spearheaded by Research Domain Criteria (RDoC), an initiative promoted through the National Institute of Mental Health (NIMH) in the U.S. that prioritizes funding for research that characterizes psychiatric concerns dimensionally (through specific behaviors, rather than diagnoses) and across multiple domains. This initiative directs much of U.S. government funding resources to basic research and away from clinical treatment trials. Additionally, NIMH funding now requires that treatment trials show evidence of directly targeting biological mechanisms. Although RDoC is a U.S. initiative, this change parallels shifting research priorities and foci internationally, but the nature of the impact is debated. The shift could be a solution to concerns that the DSM-5 diagnostic system is limited in clinical utility with somewhat arbitrary diagnostic cutoffs and based solely on observable behaviors that can be multi-determined. The new focus also could encourage innovation and improve treatment individualization for people with eating disorders, and thus improve clinical outcomes. However, there are also concerns that this initiative could divert funds from important clinical research, especially for treatments not clearly linked to a biological mechanism. Eating disorders research is underfunded relative to other illnesses globally, so it is critical that the resources be allocated in the most effective ways. There is a concern that the growing focus on basic processes may be difficult to translate to clinical practice, thus widening the research-practice gap. In this workshop, we will review the RDoC framework, discuss the potential advantages and disadvantages of this approach, and brainstorm how to foster research-practice collaborations within this framework to maximize clinical usefulness. In an interview format, clinicians and researchers will discuss the potential benefits and challenges of RDoC and related trends for 30-40 minutes and then open up the conversation to workshop participants.
- Identify multiple dimensional phenotypes relevant to eating disorders treatment.
- Identify potential advantages and challenges of a dimensional-phenotype approach for research-practice collaborations.
- Develop strategies within the eating disorder community to foster research-practice collaborations in the RDoC framework (e.g., use practitioners' feedback to identify research targets based on clinical experience; translate technical research into clinically useful information).
W 2.8 - The FREED (First Episode and Rapid Early Intervention for Eating Disorders) Project: A Novel Early Intervention Service for Young Adults
Ulrike Schmidt, PhD, Other, FAED1, Victoria Mountford, DClinPsy2, Amy Brown, DClinPsy2, Jessica McClelland, PhD1, Katie Lang, PhD1, Danielle Glennon, RN2
1King's College London, London, United Kingdom; 2South London and Maudsley NHS Foundation Trust, London, United Kingdom
Eating disorders (ED) predominantly affect adolescents and young adults. Untreated symptoms have lasting effects on brain, body and behaviour. Evidence supports the need for effective intervention in early stage illness. However, individual and service-related barriers often prevent the early detection and treatment of ED. The aim of this workshop is to describe our experience setting up and running FREED (First Episode Rapid Early Intervention for ED), a novel service for young people (aged 18-25) with recent eating disorder onset (< 3 years), embedded in a specialist adult UK National Health Service ED service. We will first provide the rationale underpinning early intervention. Using group discussion and feedback, we will explore the challenges of early intervention in participants’ practice / service. We will briefly describe our service model and the practicalities of setting up and running this service. We will discuss with participants how we seek to engage young people and their families in active recovery. This will include video footage and discussion of how we tailor treatment to early intervention patients, followed by small group reflection and discussion. We will also present data on the feasibility, acceptability and clinical outcomes of FREED and its impact on duration of untreated eating disorder (DUED) and on wait-times for assessment and treatment. We will include video feedback from patients and carers. Finally, there will be questions and discussion. Lesson plan outline: 1. Rationale for early intervention (15 mins) 2. Group discussion – what are the challenges of early intervention in your practice / service? (20 mins) 3. Brief description of the FREED service (10 mins) 4. Video footage and discussion of how we tailor treatment to patients, followed by small group reflection and discussion (40 mins) 5. Presentation of outcome data including qualitative data and video feedback from patients and carers (10 mins) 6. Questions & discussion (15 mins)
- Discuss the importance of early intervention in the ED
- Appraise the challenges of implementing early intervention in a clinical service
- Apply adapted techniques and information appropriate to the needs of this patient group.
W 2.9 - Hashtag Diversity: Dialogue in the Eating Disorders Field Through Social Media Engagement
Andrea LaMarre, MSc1, Ashley Soloman, PsyD2, June Alexander, Student, Other3, Judy Krasna, Other4
1University of Guelph, Guelph, Canada; 2Eating Recovery Center & Insight Behavioral Health Centers, Cincinnati, Ohio, USA; 3Central Queensland University, Laburnum, Australia; 4F.E.A.S.T Israel Task Force, Bet Shemesh, Israel
The diversity in the eating disorders field is crystallized in online fora. From blogs to Twitter, we can find innumerable examples of differences in perspective that infuse this dynamic field – a great benefit, but also a major challenge of the online eating disorder field. In this workshop, we address how social media can bridge major gaps between organizations, researchers, health practitioners, caregivers and people with lived experience of an eating disorder. We discuss and demonstrate practical strategies to enable effective and ethical engagement with blogging, social media, and other online forms of communication. Workshop participants, whether researchers, clinicians, or people with lived experience, will leave the workshop knowing how to understand and engage in lively discussions and debates happening online around the causes, correlates, and treatments for eating disorders. We will ask participants critical questions about how they have experienced social media (e.g., Facebook, Twitter, Instagram) and blogs and reflect on our own experiences. The presenters, each with high-level engagement in social media, will offer diverse perspectives to contribute to a thorough exploration of this topic. Each has used social media to advance their clinical, research, or advocacy pursuits. We begin the workshop by demonstrating the uses of social media and blogs, including as research tool, data gathering source, communication method, peer support platform, information provision mechanism, and research knowledge translation device. To promote discussion, we invite participants to engage with us in a dialogue about the potential barriers, drawbacks, and advantages to online engagement as bridging device. We conclude with interactive examples of techniques that allow respectful and effective sharing information dissemination, and audience engagement in online fora to encourage greater communication, transparency, and productive diversity in the eating disorder field.
- Identify strategies for respectful and productive online dialogue in the eating disorders field.
- Appraise methods of diffusing and resolving conflict that may arise through disagreements in online debates about eating disorders.
- Compare approaches to using social media and blogging to spread awareness about, and build engagement with, diverse stakeholders across the eating disorders continuum.
W 2.10 - Food Addiction: A controversial construct
Ashley Gearhardt, PhD1, Fernando Fernández-Aranda, PhD2, Susana Jiménez-Murcia, PhD2
1University of Michigan, Ann Arbor, Michigan, USA; 2Bellvitge University Hospital-IDIBELL, CIBEROBN, Barcelona, Spain
The food addiction (FA) construct has become a topic of increasing interest in the scientific community within the last five years and has diagnostic, clinical and potential therapeutic implications. Although research has shown similar vulnerabilities between food intake and addictive behaviors, there are contradictory results in the literature and a lack of longitudinal data. In this workshop the state of the FA field will be discussed, including different clinical populations, from eating disorders (ED) and obesity to behavioral addictions, and the potential effect of FA in therapy response. The main aim of this workshop is to give basic therapy guidelines for the assessment and treatment of such patients and video recorded cases will be presented. The issues considered include: a) state of the art of the FA construct and current controversies; b) patients characteristics in different clinical pictures (ED, obesity, behavioral addictions) and associated risk factors; c) evaluation procedures; d) interventions (specific vs. non-specific); (e) future research. Participants will be expected to relate what they have observed in their own clinical experience and to take an active role. The workshop should be of interest to all those involved in assessing and treating eating disorder and obese patients, such as psychologists and psychiatrists, therapists, dieticians and nurses. Bibliography and relevant handouts including case study will be given.
- Gain insight on the characteristics of the food addiction construct and studies that have been carried out on food addiction vulnerability factors.
- DIstinguish the different screening tools available for food addiction screening and how to interpret their results
- Gauge the limitations and controversies surrounding this construct
W 2.11 - Eating Disorders and Digital Technologies
David Smahel, PhD1, Michal Cevelicek, MA1, Martina Cernikova, MA1
1Faculty of Social Studies, Masaryk University, Brno, Czech Republic
Eating disorders present a substantial health problem in current society. Their development is affected by multiple individual and societal factors, including traditional and, now, also digital media. Digital technologies (especially the Internet and mobile phones) are embedded in the everyday lives of most people in Western countries: They shape not only the way we communicate, but also affect our norms, values, and behavior. Considering their potential to affect our lives, it is essential to understand their role in relation to eating disorders.
The workshop centers on the role of digital technologies in eating habits, with specific focus on the development, prevention, and treatment of eating disorders. The most recent data from ongoing research projects in the Czech Republic will be presented, including interviews with clients who suffer from eating disorders (N=30) , interviews with professionals who treat eating disorders (N=30), and quantitative data depicting the behavior of the visitors of websites focused on dieting or exercising (N = 702).
First, an overview of the current research findings will be presented in two blocks. Next, in small groups, the participants will be given an opportunity to discuss their own experience with the interaction of eating disorders and digital technologies, be it from the perspective of a researcher or a treatment professional; mixed groups of practitioners and researchers will be encouraged. The goal of the discussion will be to help connect the research findings with the workshop participants’ experience. Next, the insights exchanged in the small groups will be shared in a large group and discussed with the workshop organizers. This way, the research findings will be connected to the knowledge the workshop participants themselves carry. Also, the participants’ insights will serve to enrich the presented findings, because they, at least partially, constitute one of the studied samples–professionals focusing on the treatment of eating disorders.
- Understand the current research findings on the interaction of digital technologies and eating disorders from both the perspective of people suffering from eating disorders and the perspective of professionals who treat eating disorders.
- Understand the eating behaviors of people who use digital technologies to access content related to dieting and exercising.
- Connect the acquired understanding of the current research findings on the of interaction of eating disorders and digital technologies with their professional and/or research practice.
W 3.1 - Weight, Health, and the Growing Brain: Contemporary Considerations in Treatment Goal Weight Determination for Children and Adolescents with Restrictive Eating Disorders
Rebecka Peebles, MD1, Debra Katzman, BSc, MD, FAED2, Andrea Garber, PhD, RD3, Lisa LaBorde, BA, JD, Other4, Daniel LeGrange, PhD3
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; 2The Hospital for Sick Children, Toronto, Canada; 3University of California, San Francisco, San Francisco, California, USA; 4F.E.A.S.T., Toronto, Canada
Treatment goal weights (TGWs) are generally agreed to be important milestones in the treatment and recovery of patients with restrictive eating disorders. However, how best to determine and label them, or even whether to use them at all, remain controversial. TGWs can vary widely for individuals and among treatment programs, and this ‘apples and oranges’ reality causes considerable confusion for patients, caregivers, providers, and researchers. Some providers feel reaching a TGW is critical, while others feel TGWs should not be discussed or emphasized in treatment. For post-menarchal females, maintaining optimal menstrual function without exogenous hormones is one consideration. However, many questions remain unanswered. In the context of pediatric growth and development, how do we know when a patient has reached their TGW? What role does the patient’s historical growth curve play in calculating a TGW? How should TGWs be calculated if the patient is pre-pubertal? Male? On hormonal contraception? Stunted in linear height? Transgender? Historically overweight or low weight? Normal weight with significant eating disordered cognitions? This workshop will address these challenging clinical topics in determining pediatric TGWs. The workshop will be led by a team of clinicians and researchers (adolescent medicine, nutrition, behavioral health, and a parent advocate) who regularly care for children and adolescents with eating disorders. Discussion points include the necessity of incorporating expected pubertal growth and development, linear growth, historical growth curves, expressed cognitions, dietary habits and hormonal milestones into TGW calculations, how TGWs are 'moving targets' in pediatric patients, and how clinician and parent weight bias impact TGWs. The impact of malnutrition on the growing and developing brain will be discussed, as well as emerging findings that malnutrition may precede anorexia nervosa in certain patient subgroups. Finally, different models for presenting TGWs to patients and caregivers in different treatment paradigms will be discussed. Interactive discussion using case-based learning will engage participants and stimulate a lively dialogue. Participants will be encouraged to share interesting and challenging cases.
- Describe pubertal, growth, and cognitive considerations in setting a treatment goal weight (TGW), and explain the rationale for incorporating an individual patient’s historical growth curve in TGW determination.
- Differentiate considerations in determining TGW in the context of unique and challenging clinical issues (young children, males, transgender youth, and youth who have grown at extremes of the growth curve prior to developing an eating disorder) in children and adolescents.
- Discuss a common language for presenting TGWs to patients and caregivers, and how weight bias might influence these conversations.
W 3.2 - Suicide in eating disorders: Who is at highest risk and how do we work more effectively with these clients?
Emily Pisetsky, PhD1, Lindsay Bodell, PhD2, Lucene Wisniewski, PhD3, Scott Crow, MD1
1University of Minnesota, Minneapolis, Minnesota, USA; 2University of Chicago, Chicago, Illinois, USA; 3The Emily Program, Cleveland, Ohio, USA
Suicide is a common cause of the elevated mortality in eating disorders (ED). Although this is an oft-cited statistic, many clinicians report not knowing which individuals are at highest risk for suicide or how to effectively manage these clients clinically. Thus, during the first part of this workshop (15 minutes), Dr. Crow will review the literature on mortality in EDs and prevalence of suicide attempts. Next, Drs. Pisetsky and Bodell will discuss recent research findings on who are at highest risk for suicide attempts, including specific ED symptom presentations, comorbid psychopathology, and personality traits, as well as psychological models of suicide risk and their application for treatment and prevention efforts (15 minutes). The second half of the workshop will focus on specific clinical skills for working with suicidal clients. Dr. Wisniewski will present a case and discuss the therapeutic techniques she uses working with these clients, drawing from dialectical-behavioral therapy. She will discuss managing both acute and long-term high risk for suicide. Workshop participants will be able to ask questions about this case as well as their own challenging clinical cases. There will be opportunities for workshop participants to engage in role plays with the presenters who will provide feedback (30 minutes). The workshop will end with a discussion facilitated by all of the presenters on clinicians’ concerns about working with high risk clients and strategies to maintain self-care and professional and personal boundaries while engaging in challenging clinical work (30 minutes).
- Identify the prevalence and correlates of suicide attempts in individuals with eating disorders.
- More effectively work with clients both at acute and long-term risk of suicide.
- Use strategies to deal with the stress of working with high risk clients.
W 3.3 - The Body Project Collaborative: Building Global Partnerships for Eating Disorder Intervention Dissemination; How You Can Too!
Alan Duffy, MS1, Marisol Perez, PhD2, Phillippa Diedrichs, PhD3, Carolyn Becker, PhD, FAED4
1Eating Recovery Center / The Body Project Collaborative, Denver, Colorado, USA; 2Arizona State University, Tempe, Arizona, USA; 3University of the West of England, Bristol, United Kingdom; 4Trinity University / The Body Project Collaborative, San Antonio, Texas, USA
Dissemination of effective interventions to reduce body dissatisfaction and prevent some eating disorders (ED) is a critical public health priority. The Body Project is a dissonance-based intervention program in which young women critique the appearance-ideal. Over the past decade and a half, efficacy trials have shown that the Body Project produces greater reductions in ED risk factors (including body dissatisfaction) and symptoms relative to assessment-only control and several alternative interventions. It also has been shown to reduce the onset of some EDs. More recent research on the Body Project has focused on translation to real-world settings. These efforts have indicated very strong potential for program dissemination. In 2012, the Body Project Collaborative was formed with the intention of broadly disseminating the program around the world through unique partnerships. This workshop will begin with the presenters briefly reviewing the research supporting the efficacy and effectiveness of the Body Project and provide a succinct history of dissemination efforts prior to 2012. The core portion of the workshop will be the presenters discussing five global partnership case studies in the United States (two partnerships), Canada, Mexico, and the United Kingdom that have made scalable dissemination of the Body Project at minimal cost possible. Presenters will discuss challenges in developing global partnerships, suggest potential avenues for global partnerships in addressing body dissatisfaction as well as ED prevention and treatment dissemination; participants will be able to discuss strategies for building global partnerships with their own therapeutic/prevention/research dissemination. The presenters will guide participants through an interactive forum that will allow participants to develop a plan for beginning partnerships at the local, national, and international level for the smallest to the biggest research and practice initiatives.
- Understand how the Body Project Collaborative has developed global partnerships in multiple countries.
- Articulate the methods utilized to develop meaningful global partnerships to disseminate research, therapeutic, and prevention interventions.
- Emerge with a preliminary plan for developing partnerships to assist in dissemination of their own interventions.
W 3.4 - Integrating Basic Behavioral, Psychological, and Neurobiological Research into the Study of Eating Disorders
Amy M. Heard, BA1, Margaret Sala, BS2, Lauren E. Breithaupt, MA3, Kendra R. Becker, PhD4, Jason M. Lavender, PhD5
1Loyola University Chicago, Chicago, Illinois, USA; 2Southern Methodist University, Dallas, Texas, USA; 3George Mason University, Fairfax, Virginia, USA; 4Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA; 5Neuropsychiatric Research Institute, Fargo, North Dakota, USA
Translational research seeks to apply findings from basic behavioral, psychological, and neurobiological research to treat disease and improve well-being. This workshop focuses on integrating these areas of research and obtaining funding in the study of eating disorders (ED). The workshop will begin with a moderated group discussion (Heard) of how basic behavioral, psychological, and neurobiological research intersects with clinical intervention in the ED field (5 mins). After this initial discussion, panelists will present examples of how their own research fits within a translational model. One panelist (Lavender) will discuss the National Institute of Mental Health (NIMH) Research Domain Criteria (RDoC) initiative, which seeks to integrate basic dimensions of human functioning into the study of mental disorders, and describe ED research consistent with this framework (15 mins). Two panelists (Heard, Sala) will build on this discussion by presenting an integrated model of reward and affect regulation within anorexia nervosa (10 mins). Another panelist (Breithaupt) will discuss the application of neuroimaging research investigating reward processing to bulimia nervosa (10 mins). Participants will then have an opportunity to ask questions about presented research (10 mins) before breaking into groups to discuss methods of incorporating translational research in their own work (15 mins). The workshop will end with a moderated group discussion (Heard) on available funding opportunities to conduct translational research. Graduate students, postdoctoral fellows, and early-career investigators (Breithaupt, Sala, Becker, Lavender) who have received funding from the National Science Foundation and the NIMH will describe how funding agencies define “basic” research and distinguish it from clinical research (5 mins). Participants will have an opportunity to ask questions and receive advice from panelists on leveraging such grants to fund ED research (20 mins). Didactic: 40 mins Interactive: 50 mins
- Understand the role of translational research in the study of eating disorders
- Identify funding mechanisms that may be relevant for translational research in the study of eating disorders.
- Discover ways in which current research questions may be answered by using more basic behavioral, psychological, and neurobiological research.
W 3.5 - Integrating Research Evidence for a Novel Emotion Skills Training Intervention
Kate Tchanturia, DClinPsy, PhD, FAED1, Marcela Marin Dapelo, PhD2, Heather Westwood, Student2
1King's College London/Maudsley Hospital, London, United Kingdom; 2King's College London, London, United Kingdom
The aim of this workshop is to synthesize research and clinical practice on socioemotional functioning in eating disorders. The workshop will be split into four sections, two of which are more didactic and two more interactive in nature. In the first section, we will describe how experimental findings on emotion expressivity and research exploring co-occurring Autism Spectrum Disorder traits have complimented our understanding of socio-emotional functioning. Our systematic evaluation of the literature in eating disorders and related conditions clearly shows reduced expressivity of emotions through facial expression during the acute phase of illness and the presence of co-occurring autistic symptoms in a significant proportion of patients with eating disorders. The most important findings in the area will be presented to the attendees in this section (15 minutes). In the second section, attendees will gather together in small groups to discuss how emotional difficulties and the presence of co-occurring autistic symptoms can make treatment for eating disorders challenging (20 minutes). In the third part, we will share with the workshop attendees recent experimental work which we have conducted using facial expression experimental work and how we have translated this into the Cognitive Remediation and Emotion Skills Training (CREST) manualised treatment package (20 min). Finally, we will demonstrate some experiential exercises we have used in emotion skills training sessions with patients with eating disorders and novel possible extensions of CREST, focusing on difficulties with social interaction (20 min).
- Identify difficulties with socioemotional functioning which are commonly experienced by patients with eating disorders in intensive clinical care.
- Apply experimental methods to study expressivity in patient with eating disorders.
- Demonstrate how research findings can be translated into clinical practice through the use of experiential exercises.
W 3.6 - Multidisciplinary Teaching Methods: Engaging the Next Generation
Melissa Nishawala, MD1, Kate Cheney, MD1, Michelle Miller, PsyD1, Bridget Murphy, MS1, Andrea VAzzana, PhD1, Lisa Kotler, MD1
1New York University, New York, New York, USA
Many clinicians reach the end of their training reporting that they do not feel equipped to treat patients with eating disorders. In addition to the obvious obstacle of lack of knowledge regarding eating disorders, bias and reluctance to delve into sensitive topics keep trainees from recognizing important signs and symptoms. The first step in gaining the confidence to treat eating disorders is becoming comfortable in asking tough questions and doing so with compassion and without judgement. The teaching modalities presented in this workshop were developed to teach medical students during an inter-clerkship intensive week of studies on addiction, nutrition and behavior change; enhanced by strategies used to engage students in our undergraduate minor in child and adolescent mental health studies; and adapted to use with a broad base of learners, including psychology interns, post-doctoral fellows, child psychiatry fellows, general psychiatry residents, and social work students, as well as faculty who have not yet specialized in eating disorders. After a brief introduction (5 min), we will spend the remainder of the workshop demonstrating our interactive teaching methods incorporating viewpoints from our different disciplines of psychiatry, psychology and nutrition. This will include:· Live poll quiz (20 min) · Team -based learning using multidisciplinary format (25 min)· Live interview role play (25 min) · Panel discussion with Q & A including all presenters (15 min) Each section will include away-points to help participants to develop their own curricula. Emphasis will be placed on creating excitement for learning, understanding bias, eliciting sensitive information, avoiding judgment, and facilitating entry into effective treatments. Participants will receive practical teaching skills to engage groups of all types including undergraduate students, professional students and clinicians of all disciplines.
- Identify the weaknesses in standard, didactic learning.
- Integrate innovative, interactive teaching methods into previously developed curricula.
- Encourage trainees to challenge biases that act as barriers to accessing treatment .
W 3.7 - Spotlight on the Needs of Children with Eating Disorders
Dasha Nicholls, MBBS1, Catherine Stewart, PhD2, Cathaline Tangau, MSc3, Nadia Micali, MD4
1Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; 2South London and Maudsley NHS Foundation Trust, London, United Kingdom; 3University College London, London, United Kingdom; 4UCL Institute of Child Health, London, United Kingdom
Although described in the literature since 1894, childhood (preadolescent) onset eating disorders (ED) were once considered a relatively rare phenomenon. A possible rise in incidence of childhood ED coincides temporally with a rise in obesity, and associated efforts to combat this. This workshop will: 1] review the epidemiology of childhood onset ED across countries, exploring evidence for temporal trends (10 mins) 2] present new data from a two site retrospective case notes study looking at triggers for onset of childhood ED (10 mins) 3] review diagnostic and assessment procedures in this age group (10 mins) and 4] discuss how developmental differences inform adaptations to early intervention and standard treatment and consider the role of community education/prevention based approaches (10 mins introduction, 50 mins interactive discussion using clinical case material).
- Calculate the likely incidence of childhood EDs in their context and recognize where further data are needed
- Develop an assessment protocol for younger patients
- Anticipate the treatment needs of this patient cohort within their own setting
W 3.8 - Cue exposure therapy for binge eating-related disorders using virtual reality
Marta Ferrer-Garcia, PhD1, José Gutiérrez-Maldonado, PhD1, Joana Pla-Sanjuanelo, MPsych1, Ferran Vilalta-Abella, MPsych1, Giuseppe Riva, PhD2, Antonios Dakanalis, PhD3
1University of Barcelona, Barcelona, Spain; 2Università Cattolica del Sacro Cuore, Milan, Italy; 3Università degli Studi di Milano-Bicocca Milano, Milan, Italy
This workshop provides information on the use of a virtual reality-based intervention for cue-exposure therapy (CET) in patients with binge eating-related disorders (BERD) resistant to treatment. Cognitive-behavioral therapy (CBT) is usually recommended as the first-line treatment for both bulimia (BN) and binge eating disorder (BED) and there is a strong body of research supporting its efficacy. However, a large percentage of patients do not improve despite treatment. Consequently, several approaches have been proposed to improve standard interventions. CET is based on the classical conditioning model and aims to extinguish food craving and anxiety associated with binge behavior through breaking the bond between the conditioned stimuli (e.g., palatable food, emotional states) and the unconditioned stimulus (intake of binge food). Previous research shows that CET is effective in reducing food craving, anxiety and binge behavior. However, logistical difficulties and the time needed to apply CET have hindered its development and implementation. Virtual reality (VR) technology is a powerful resource for simulating real-life situations in which CET can be used while ensuring security, privacy, flexibility, ecological validity, and control of the situation. Given that, new VR-based software for CET has been developed for administration as a component of BERD treatment. This workshop is structured in three parts. First, the efficacy, applicability and rationale of CET are briefly summarized. Second, the VR-based intervention is presented. Information on its development and use will be provided and attendees will be able to test how it works. Third, an experiment with the use of VR-based CET in patients with BN and BED resistant to treatment will be presented. Data on the efficacy of the software will be provided and several clinical cases will be discussed.
- To review the rationale of cue-exposure therapy for binge eating-related disorders and to analyze available studies of its efficacy, applicability and current drawbacks.
- To use new software based on virtual reality technology for cue exposure therapy in binge eating-related disorders.
- To integrate virtual reality-based cue-exposure therapy in the treatment of binge eating- related disorders, to analyze the main advantages and disadvantages of the software, and to identify patients especially likely to benefit from its use.
W 3.9 - Home Treatment in Greece: Working with Families and Patients with Severe AN according to the Interpersonal Component of Cognitive Interpersonal maintenance model.
Maria Tsiaka, BA, Student1, Maria Tsiaka, BA, Student2, Angeliki Zormpala, BS, MSc2, Janet Treasure, PhD, FAED1, Constantinos Bletsos, BSc, MSc, Student3
1Institute of Psychiatry,Psychology and Neuroscience , King's College, London, United Kingdom; 2Hellenic Center For Eating Disorders, Athens, Greece; 3Adolescent Inpatient Unit ,Sismanoglio Hospital, Athens, Greece
Home treatment is emerging as an alternative treatment plan to hospital admission for adolescents and adults with acute or severe anorexia nervosa in Greece due to the lack of specialized inpatient and day care units. Moreover, the home treatment program includes intensive monitoring, supervision of meals at home, or additional individual/family support that usually lasts approximately 16 weeks. It is a family centered approach, which aims to address the patient’s psychological and age- related needs in the home environment. Further, it is designed to empower and support family members, reduce the parental burden, and enable the family to live a normal life. Take into consideration that substantiated research indicates that familial factors can contribute to the maintenance of eating disorders; the family intervention of home treatment is based on the theory of the maintenance model for anorexia nervosa that is proposed by Schmidt and Treasure in 2006. Specifically, this model suggests that the caregivers' emotional reactions are characterized by high levels of anxiety and depression, psychological distress and dysfunctional responses to the illness in the form of Expressed Emotions or accommodation to symptoms, can act as maintaining factors of an eating disorder. Also, the model has been applied to the home treatment program for the last four years and its efficiency is currently under study.
- Describe the phases of home intervention, focusing on implementation of the interpersonal maintenance model for anorexia nervosa.
- Increase their knowledge of the application of this model in the home environment by using role-playing based on scenarios and real case material
- Discuss the advantages and disadvantages of home treatment.
W 3.10 - E-health for eating disorders: Featback as example
Eric van Furth, PhD, FAED1, Alexandra Dingemans, PhD2, Jiska Aardoom, PhD2
1Rivierduinen Eating Disorders Ursula/LUMC, Leiden, Netherlands; 2Rivierduinen Eating Disorders Ursula, Leiden, Netherlands
E-health interventions decrease barriers to care, because they are widely available and more easily accessible than traditional face-to-face treatment. Internet-based interventions have the potential to provide promising ways to enhance health care . In the first part of the workshop we will critically review, and discuss with participants, the emerging evidence for e-mental health for eating disorders. We will provide an update on our published reviews on this topic (PMID 26946513 and PMID: 23674367). Next we will provide a comprehensive overview of the results of our randomized controlled trial of Featback, a psycho-education and automated self-monitoring system with added psychologist support. We will briefly present and integrate the effectiveness (PMID: 27317358), cost-effectiveness (PMID: 27441418), predictors and moderators (what works for whom), mediators (mechanisms of change) and the results of a content analysis of the support sessions. This ‘360-view’ on Featback provides input for the discussion with participants about the clinical utility of anonymous e-health interventions and next steps in research and clinical practice. Finally, we will introduce the brief psychologist led online-interventions used in the support sessions of our RCT. In pairs of two, participants will practice briefly with this model.
- Following this workshop participants will be able to appraise the state-of-the-art in the emerging field of e-health for eating disorders.
- Following this workshop participants will be able to appreciate the scope (strengths, limitations) of e-health for eating disorders .
- Following this workshop participants will be able to integrate the different perspectives of the results of an RCT on an anonymous e-health intervention.
W 3.11 - Research-Practice Integration: How Do I Actually Integrate in a Real-World Setting?
Caitlin Martin-Wagar, BA, MA1, Kelly Bhatnagar, PhD2
1The University of Akron, Akron, Ohio, USA; 2The Emily Program, Beachwood, Ohio, USA
The purpose of this workshop is to present a model for integrating research and practice in real-world clinical settings that is both practical and feasible. Additionally, strategies for researchers and clinicians to collaborate in obtaining clinically relevant data will be provided. While the scientist-practitioner model is highly valued in the field of psychology, it often feels unattainable to actually implement the model. Reasons such as a lack of funding, interest, or resources have been cited as barriers to true research-practice integration. However, even if clinicians are delivering evidence-based treatment (EBT), without program evaluation or research examining their treatment delivery, it can be difficult to discern how effective the EBT is in their specific practice. Evaluating outcomes is also vital when making adaptations to empirically supported models for more practical use in clinical settings. As clinical practice continues to be more linked to managed care and the larger healthcare system, program evaluation is increasingly mandated by stakeholders, accreditation agencies, and insurance companies. A step-by-step procedure describing how to integrate research and practice in clinical settings will be provided and examples from the presenters’ own eating disorder research-practice integration team will be described. Additionally, major obstacles the team faced during development and implementation of research-practice procedures will be reviewed. This workshop aims for both primary clinicians and primary researchers to find concrete ways to more realistically integrate research and practice. · Overview and rationale of the importance of the integration of research and practice for eating disorders (20) · Group discussion on barriers to integration (15) · Description of processes one Midwestern outpatient eating disorder specialty clinic took to integrate research and practice; description of obstacles faced during this implementation and step-by-step suggestions (20) · Video clips from members of the research-practice integration team on what they feel they have gained from this approach (5) · Small group discussions to problem-solve perceived barriers (15) · Wrap up with audience members action plans/goals to move towards more fully integrating research and practice (15)
- Describe the process the research-practice integration team used to develop procedures in an outpatient clinic that integrate clinical work and research.
- Problem-solve barriers to developing or enhancing research-practice integrations in primary clinical and primary research settings.
- Develop concrete steps to reduce the research-practice gap at host institutes.
- This page maintained by: Dawn Gannon
- Last Updated: 23 March 2017