Clinical Teaching Day | Session 1
Wednesday, May 31
9:00 AM - 6:00 PM ET
Key skills in delivering 10-session CBT-T for non-underweight individuals with eating disorders
Dr. Glenn Waller, University of Sheffield
Jessica Beard
Cognitive-behavioural therapy for eating disorders (CBT-ED) is strongly supported for adults and adolescents with eating disorders. CBT-T is a brief version of CBT-ED (10 sessions) that has demonstrated strong effectiveness for adult and adolescent eating disorder patients who are not severely underweight, helping them to overcome their eating disorder. Using CBT-T allows clinicians to treat people effectively more quickly, and hence to shorten waiting lists. It is a flexible protocol, adaptable to the individual patient’s needs. It differs from other forms of CBT-ED in a number of ways, explaining its faster effect (e.g., use of exposure therapy; wider toolkit for body image work).CBT-T provides an evidence-based protocol that can be delivered by junior or senior clinicians, helping patients to recover and go on to live a healthy life. During this eight-hour training, participants will get an overview of the principles and evidence underpinning CBT-T, and will learn the skills needed to administer CBT for eating disorders effectively and efficiently. Role plays will be used to illustrate skills throughout. The session will end with consideration of new developments in CBT-T.
Presentation Level: Intermediate
Clinical Teaching Day | Session 2
Wednesday, May 31
9:00 AM - 1:00 PM ET
The Challenge of Anorexia Nervosa: Expanding Your Toolbox with Interventions from ACT
Dr. Rhonda Merwin
Associate Professor, Duke University Medical Center
Acceptance and Commitment Therapy (ACT) is a contemporary CBT with widespread interest and growing empirical support. ACT is a transdiagnostic therapeutic model targeting psychological inflexibility and has been tested with an impressive array of clinical conditions (Gloster, Walder, Levin, Twohig & Karekla, 2020). Although research with eating disorders (EDs) is still early, a recent review of the literature identified 22 studies with a total N=674 on ACT for eating disorders, including 5 RCTs (Onnink, Konstantinidou, Moskovich, Karekla & Merwin, 2022). For the clinician treating individuals with anorexia nervosa, ACT may expand the therapeutic toolbox or offer alternative strategies when other approaches have yielded suboptimal results. ACT may be well-matched to anorexia nervosa given its target of inflexibility stemming from experiential avoidance (i.e., attempts to avoid or control unwanted internal experiences), cognitive fusion (i.e., overattachment to the content of mental activity to the neglect of direct experience) and a lack of clarity in personal values. The workshop will provide a broad overview of ACT model and concrete tools for case formulation and intervention with individuals with anorexia nervosa (and the spectrum of anorectic behavior). Participants will sample interventions from the 3 pillars of the ACT model: open (acceptance, defusion), centered (present moment awareness, self-as-context) and engaged (values, committed action), observe live demonstrations, discuss case examples and participate in transcript review. Participants may also have the opportunity to practice implementing interventions in small groups, as time allows. This workshop is based on extensive experience training practitioners in ACT and ACT for EDs as a Peer-reviewed ACT trainer recognized by the Association for Contextual and Behavioral Science and methods outlined in the first manual on ACT for Anorexia nervosa (Merwin, Zucker & Wilson, 2019).
Learning Objectives:
- Describe the ACT model and the core processes of chang.
- Formulate cases of anorexia nervosa (or anorectic behavior) from an ACT perspective.
- Implement new interventions with individuals with anorexia nervosa that leverage elements of the 3 pillars of the ACT model.
Presentation Level: Intermediate
What Am I Bringing In the Room?: Working towards decolonizing the treatment of eating disorders
Laura Jones, LPC
Wild Feather Counseling
This interactive workshop aims at tackling diversity from another angle. Many workshops and classes focus on understanding key qualities when working on specific communities. There is much that can be learned from these discussions, such as how to address body image concerns with a transgender client in a trans-friendly manner. However, no community is a monolith and it is impossible to know everything about the identities a client holds walking into our office.
This session focuses on the importance of the clinician/practitioner understanding their own identities and privileges so that when a client comes in they are aware of how differing identities may impact their work together. While it is not possible to always “do the right thing”, it is possible to manage one’s shame.
This workshop will be applicable to eating disorder treatment because it will also focus on the influences of white supremacy and colonization, which impacts the clients at a systemic level as well as on an individual level. Dynamics that regularly emerge within clinician/client work together include perfectionism, black-and-white thinking, one right way, urgency, progress is pivotal, will power, and many others; but how often are these topics addressed at a systemic level? Oppression is about the group in power making everyone else feel “othered” and “less than.” These core beliefs are often underlying eating disorders, anxiety, depression, etc. How often do these issues go unnamed because a clinician doesn’t want to “step in it” or be consumed by shame? Decolonizing our minds and decolonizing the treatment of eating disorders is messy work!
Clinicians need a space to be messy and to examine their own identities, power, and privilege so that their clients aren’t the only ones educating them. Case studies will be a critical part of this journey, as they provide opportunities for clinicians to note their inner reactions to specific scenarios. These cases will allow them to brainstorm their responses and hear how others, including the presenter, would respond. This workshop is based on the premise that “lived experience is experience”. Open discussion and participation in the workshop by anyone with lived experience will be encouraged.
Learning Objectives:
1. Following the training, participants will be able to identify and discuss their own identity, power, and privileges, understand how to integrate these concepts into their work with clients, and recognize why that is critical.
2. Following the training, participants will be able to compare and contrast shame and guilt and define how shame prevents clinicians from being able to truly help their clients.
3. Following the training, participants will be able to recognize the characteristics of white supremacy; outline ways to disrupt them; and use case examples to demonstrate how these show up in a clinicians’ interactions with someone who has an eating disorder.
Presentation Level: Introductory
Clinical Teaching Day | Session 3
Wednesday, May 31
2:00 PM - 6:00 PM ET
Designing & Implementing DBT-ED Programming for Youth in Day Treatment:The Challenges and the Hope
Anita Federici PhD, CPsych FAED, Psychologist, The Centre for Psychology and Emotion Regulation
Dr. Seena Grewal, Psychiatric Director, Provincial Eating Disorder Program, BC Children's Hospital
Recent years have seen an increase in severity and complexity of children and youth with eating disorders (ED). While outpatient treatments like family-based treatment (FBT) or cognitive behaviour therapy (CBT) may be effective for a subset of youth, there is a substantial demand for innovative and comprehensive treatment models that can manage the ED in the context of emotion regulation problems, suicide, and self-injury. In particular, treatment providers have voiced concern over limited responses to existing treatment models, citing high relapse rates, caregiver inability to commit to treatment expectations, and significant motivational issues for youth. Others identify concerns with following patients for years in higher levels of care without progress, high burnout and staff turnover, and hopelessness in families.
Dialectical Behavior Therapy (DBT) is an evidence-based treatment that is increasingly being employed to support youth who struggle with emotional regulation and suicidal ideation in the context of eating disorder treatment who may have had a partial response or are not able to participate in FBT, a common outpatient treatment for adolescents with eating disorders. Models of care using elements of FBT and DBT to support youth with eating disorders are increasingly being employed by treatment providers. This workshop will discuss how to implement dialectical behaviour therapy into higher level treatment programs for adolescents in hospital and community-based settings, particularly those who have been employing an FBT-informed approach. Using clinical examples from cross program work conducted in Canada, the workshop will explore how to redesign, retrain, implement, and study the DBT-FBT model in adolescent day treatment programs. We will discuss how day hospital or partial hospitalization programs can benefit from the incorporation of DBT and suggest different models for the delivery of the content. Change management strategies including how to train multidisciplinary teams, orient stakeholders to DBT concepts, and addressing budget and administrative constraints will be reviewed.
Learning Objectives:
- Recognize how FBT informed approaches can be incorporated into day programs alongside DBT.
- Identify the benefits and challenges of incorporating dialectical behaviour therapy into higher level treatment programs for individuals with eating disorders.
- Explain change management strategies for successful implementation of DBT into eating disorder programs.
Presentation Level: Intermediate
Caring For Those Who Are Missed: Cutting-Edge Outpatient Medical Treatments That Make a Difference
Dr. Jennifer Gaudiani, CEDS-S, FAED
Gaudiani Clinic
Abstract:
The community of eating disorder professionals frequently expresses the desire to improve care and outcomes for those with eating disorders. However, outpatient medical care for people with eating disorders remains grossly inadequate. In the medical world, sizeism, collusion with diet culture, mental health stigma, overemphasis of measurable illnesses, consternation about the complexities of treating those with eating disorders, and a lack of training on the medical consequences of eating disorders all contribute to patients’ at best inadequate, at worst traumatizing and relapse-inducing, experience in outpatient medical settings. Dr. Gaudiani has been providing expert outpatient medical care to patients of all ages, genders, and body sizes with eating disorders from around the United States since 2016. Her unique clinic is a referral center for some of the most medically complicated patients with eating disorders in the US, and as such has allowed for a unique expertise to grow. This medical care applies to a highly diverse group of patients, reflecting the complex individuals that outpatient therapists and dietitians treat, often without medical support.
In this talk, Dr. Gaudiani will discuss the appropriate medical care of multiple populations of patients who are particularly missed and harmed, including those with severe and enduring eating disorders, “atypical” anorexia nervosa, adult avoidant restrictive food intake disorder, highly complex digestive dysfunction, postural orthostatic tachycardia syndrome, post traumatic stress disorder so activating that it prevents recovery work, and mast cell activation syndrome. These patients are the ones often felt to have “refractory illness,” to have somatic symptom disorder, to be too medically complicated for many residential eating disorder settings. These patients often despair because they, too, feel they must be irrevocably broken and impossible to help. However, the truth is that with thoughtful, curious, respectful, and informed medical care, many of these patients thrive. Disseminating information to the international eating disorder clinician community about these medical diagnoses and treatments that make such a difference should meaningfully move the needle on overall outcomes for those with eating disorders.
Learning Objectives:
1. Identify groups of patients with eating disorders who are particularly missed and harmed by typical outpatient medical care, and the systemic roots of such harm.
2. Recognize symptoms and diagnoses that may be amenable to improvement with informed medical care.
3. Appreciate a wide array of therapeutic options (both prescription and non-prescription) that may meaningfully improve patients' quality of life and allow for improved engagement in eating disorder recovery work.
Presentation Level: Intermediate