Workshop Summary Session 1

Educational Session 1: Concurrent Workshops & SIG Panels
Thursday, March 14, 3:00pm - 4:30pm

Workshop: Multi Family Therapy in the Virtual World

Kristen Anderson, LCSW, CEDS-S, Chicago Center for Evidence Based Treatment
Dr. Julian Baudinet, King's College London
Dr. Karen Bernstein, MD, MPH, University of Illinois-Chicago, Director, Division of Adolescent Medicine
Sara Desai, Co-Founder, CCEBT
Stamatoula Voulgari PhD, Principal Systemic Psychotherapist / Training Manager, Maudsley Centre for Child and Adolescent Eating disorders (MCCAED)
Ivan Eisler, PhD, Clinical Psychologist, South London and Maudsley NHS Foundation Trust

Abstract: Traditionally, Multi Family Therapy for Anorexia Nervosa (MFT-AN) has been delivered in person for families with young people with restrictive eating disorders. MFT-AN interventions are informed from the principles of family based treatment (FBT)/family therapy for Anorexia Nervosa (FT-AN) models. This intervention offers families in vivo support while connecting with other families to increase knowledge of eating disorders, reduce the sense of isolation and develop skills related to successfully supporting their young person through difficult times. The team at Chicago Center for Evidence Based Treatment are in the process of conducting a trial of a virtual based Multi Family Therapy for Anorexia Nervosa. This workshop, presented by an international panel of MFT clinicians and researchers, will provide (a) an update on Multi Family Therapy theory and research (5 min), (b) highlight the key differences between virtual MFT and in-person MFT (20 min), (c) illustrate Multi Family Therapy in practice through experiential exercises for participants (45 min) and (d) engage participants in Q + A/discussion related to virtual/in person MFT.

Learning Objectives:

Demonstrate a working knowledge of the delivery of Multi Family Therapy.
Identify differences between implementing MFT virtually and in person.
Practice skills related to effectively delivering MFT exercises/activities.

Workshop: A Weight-Inclusive Approach for Calculating Estimated Target Weights for Adolescents

Lauren Muhlheim, PsyD CEDS-S, FAED, Eating Disorder Therapy LA
Rebecka Peebles, MD, FAAP, Vice President of Adolescent Medicine, Monte Nido & Affiliates
Brooks Sumner, Registered Dietitian Nutritionist, EDRD Pro (TM)

Abstract: Weight restoration is an essential component of eating disorder recovery. However, there is no consensus on how to set recovery weights. Research has often relied on reaching a BMI of at least 18.5 or using median 50% BMI. Given that many people with restrictive eating disorders never reach BMIs this low, this makes little sense. Using methods such as these may keep people genetically predestined to live in larger bodies in a state of chronic illness and/or vulnerable to relapse. It is imperative to consider an individual’s previous growth trajectories with an individualized approach when information is available to do so.

This team of a pediatric medical doctor, registered dietitian nutritionist, and psychologist will review the research and lived experience evidence supporting the need for higher recovery weights for many patients. They will review how to challenge weight stigma in patients, families, and other providers when restoring teens to higher weights. Finally, they will teach a step-by-step method using individualized growth curves, mid-parental heights, and pubertal staging for estimating recovery weights. Participants will be given sample growth data and will gain experience practicing estimating recovery weights using this method.

This team of a pediatric medical doctor, dietitian nutritionist, and psychologist will review the research and lived experience evidence supporting the need for higher recovery weights for many patients. They will review how to challenge weight stigma in patients, families, and other providers when restoring teens to higher weights. Finally, they will teach a step-by-step method using individualized growth curves, mid-parental heights, and pubertal staging for estimating recovery weights. Participants will be given sample growth data and will gain experience practicing estimating recovery weights using this method.

Learning Objectives:

Participants will be able to describe the rationale behind setting individualized recovery weights for teens with eating disorders.
Participants will be able to facilitate an open discussion with patients, parents, and families about the reasons to restore teens with higher weights according to historical growth curves to higher weights.
Participants will be able follow the 7-step process for setting recovery weights using historic growth curves.

SIG Panel: Increasing Belonging in Neuroscience and Eating Disorders: A Solution-focused Approach

Sponsored by the Neuroimaging SIG

Sasha Gorrell, PhD, UCSF Department of Psychiatry and Behavioral Sciences
Kelsey Hagan, Assistant Professor, Virginia Commonwealth University
Lisa M. Anderson, University of Minnesota
Felicia Petterway, Graduate Student, Temple University
Joanna Steinglass, Director of Research of the Eating Disorders Research Clinic, Columbia University Irving Medical Center, New York State Psychiatric Institute
Dr. Kamryn Eddy, Massachusetts General Hospital
Lauren Breithaupt, PhD

Abstract: Over recent years, our Academy members have consistently discussed inequity in our ranks, most commonly identifying the inadequate representation of racially minoritized individuals and sexual and gender minority individuals among those who participate in and conduct research efforts. Within neuroscience, we have worried about the generalizability of our findings, given that the pervasive and harmful “skinny, white affluent girl” (SWAG) stereotype of eating disorders has unfortunately influenced how we have traditionally recruited participants. Moreover, we have actively denounced the notorious “leaky pipeline” that contributes to the absence of women in research positions and encouraged efforts to shift our collective culture. With these challenges in mind, a critical perspective that has largely been missing from our broader discourse is a solution-focused approach to increasing belonging across all levels of neuroscientific engagement. This panel draws together a group of individuals who will discuss how they are actively working on increasing equity and diversity in their respective milieus, and speak to key areas of focus that will lead to improved approaches to (1) boosting diversity in research participants to ensure that the conclusions we draw are representative; (2) training the future, i.e., increasing diversity of our trainees/learners; and (3) recruitment and retention of diverse faculty. Our panelists represent researchers with experience in the neuroscience of eating disorders at the trainee, early-career, and mid-career levels, and will each engage in conversation about mechanisms of change that have allowed for shifts in their collective experience of belonging. They will discuss barriers to change and how these might be overcome. Ultimately, the panel aims to generate suggestions for how to ‘bring it home,’ and disseminate identified change in increasing representation and belonging in neuroscience and eating disorders locally.

Learning Objectives:

Identify specific mechanisms of change that have allowed for cultural shifts in promoting marginalized groups in neuroscientific research.
Discuss barriers to change, both in policy and practice, and how these can be overcome in the field of neuroimaging.
Describe methods for increasing representation in neuroimaging research samples.

Workshop: Expanding the Reach of Treatment: A Focus on Equitable Treatment Access for Medicaid Recipients

Suzanne Straebler, PhD PMH-BC, New York Presbyterian Weill Cornell Medicine
Dominique White, New York Presbyterian Weill Cornell Medicine
Samantha Berlow, New York Presbyterian Weill Cornell Medicine
Melissa Cemel, New York Presbyterian Weill Cornell Medicine
Jennifer Panitz, New York Presbyterian Weill Cornell Medicine
Alicia Hoffman, The Children's Hospital at Montefiore
Laura Cordella, New York Presbyterian Weill Cornell Medicine

Abstract: Significant disparities exist in the availability of evidence-based treatments for eating disorders. Many barriers to explain this inequity have been identified. These include low levels of treatment seeking related to stigma and cost; inadequate training on eating disorders, leading to under/mis diagnosis; insufficient number of adequately trained therapists leading to poorly implemented therapies and lengthy waitlists; the current treatment model of one-to-one therapy resulting in inefficient delivery; financial burdens associated with treatment, such as costs related to transportation to attend sessions and expenses tied to essential treatment materials including the cost of food and supplement drinks (food insecurity) ; and a lack of treatment research on representative patient samples and relatedly, limited culturally sensitive treatment protocols. While these barriers are encountered by individuals with eating disorders generally, individuals with public insurance (e.g., government-issued Medicaid/Medicare), in the United States, are particularly vulnerable to encountering several, if not all, of these obstacles. Our two hospital-based clinics serve a diverse and inclusive patient population, a substantial portion of whom receive public insurance. In an effort to expand the reach of effective treatments to all patients with eating disorders we have identified a number of specific barriers encountered by this group and implemented a variety of strategies to reduce these obstacles. In this workshop, we provide guidance for therapists on expanding the reach of two recommended treatments for eating disorders: family-based therapy (FBT) and enhanced cognitive behavior therapy for eating disorders (CBT-E). We will share our experience with the aim to engage the group in a lively and thoughtful discussion on the topic serving to increase attendees, and our own, understanding of the specific challenges faced by these patients and collaboratively develop potential solutions.

Learning Objectives:

Participants will gain knowledge of the challenges publicly insured individuals encounter when accessing evidence-based treatment for eating disorders.
Participants will be provided with potential solutions to some of the barriers this patient group encounters in accessing care.
Participants will identify and brainstorm further obstacles collectively with session leaders.

Workshop: Managing Dissociative Symptoms in Individual and Group Therapy

Eva Schoen PhD, University of Iowa Hospitals and Clinic

Abstract: Many patients with eating disorders also suffer from concurrent trauma-related disorders (Convertino, Morland, & Blashill, 2022). A subset of these patients may present with dissociative symptoms, such as memory lapses, a sense of detachment, and numbing or spacing out. Dissociative disorders in the DSM 5 include a range of disorders from dissociative symptoms in the context of another disorder (OCD, BPD) to PTSD dissociative subtype, Depersonalization Disorder, and Dissociative Identity Disorder (DID). Providers working with patients with eating disorders are likely to encounter patients with dissociative symptoms, especially as the eating disorder disorder itself may also feature dissociative components, such as emotional and physical numbing from starvation, out-of-body experiences, or detachment from self and others. During the didactic part of this workshop, the different types of dissociative disorders and dissociative symptoms will be reviewed. The presenter will introduce the structural model of dissociation. Assessment measures for dissociation will be shared. During the experiential part of the workshop, interventions for working with patients with dissociative symptoms will be shared. These interventions will be grouped into grounding skills training, psychoeducation, and parts work and will be demonstrated in the workshop. While these interventions can be utilized in an individual or group therapy context, special consideration will be given to utilizing these interventions with patients who actively dissociate while in groups. Attendees will have the opportunity for small group discussion centered around case examples.

Learning Objectives:

Describe dissociation and the different dissociative disorders in patients with eating disorders.
Discuss the structural dissociation model.
Explain psychoeducation, grounding skills, and parts work interventions for individual and group therapy.

Workshop: Navigating the Intersection of ARFID and AN: Strategies for Nutritional and Behavioral Management

Dr. Blair Uniacke, MD, Columbia University/New York State Psychiatric Institute
Evelyn Attia, Columbia University/New York State Psychiatric Institute
Angela Guarda, Johns Hopkins School of Medicine
Colleen Schreyer, Johns Hopkins School of Medicine

Abstract: Admissions for intensive treatment of patients with Avoidant Restrictive Food Intake Disorder (ARFID) in specialized eating disorder programs are rising yet empirical data to guide care in these settings is sparse. Even less evidence is available to inform treatment approaches for patients with anorexia nervosa (AN) and a history of ARFID and/or ARFID-like symptoms. This workshop will review existing literature and employ case-based learning and group discussion to examine challenges and potential solutions for providing evidence-based care to this complex group of patients in an intensive treatment setting. In the first half of this workshop, we will review the literature on admission symptomatology and treatment outcomes for adults and adolescents with ARFID in intensive (i.e., inpatient, residential, partial hospitalization) eating disorder programs. Clinical case presentations will be used to illustrate approaches for renourishing underweight patients with ARFID in these settings. We will discuss the application of nutritional protocols and behavioral interventions informed by both cognitive behavioral and meal-based exposure approaches to care. Common challenges will be identified with a focus on pragmatic approaches to maximize the effectiveness of behavioral interventions. Speakers will emphasize symptom commonalities (e.g., fear of aversive consequences, limited food repertoire) between the two disorders. Goals of this exercise will include balancing individualized care with protocol-based group and milieu treatments that include elements of contingency management. The second half of the workshop will be interactive and will focus on case-based learning to illustrate treatment of clinically complex patients with ARFID and/or restrictive eating disorder symptoms that sit at the intersection of ARFID and AN. Participants will meet in small groups moderated by a workshop faculty member to review a case, identify potential treatment challenges, and brainstorm treatment plan goals. The larger group will reconvene for case presentations and discussion. We will conclude the workshop with a group discussion focused on unanswered questions, and brainstorming how to balance evidence-based approaches with creativity in meeting the needs of particular patients. Through this workshop, participants will acquire new strategies and skills for the nutritional rehabilitation and behavioral treatment of underweight patients with ARFID in intensive treatment settings.

Learning Objectives:

Describe current approaches to nutritional rehabilitation for patients with ARFID in intensive eating disorder treatment settings.
Identify potential challenges to successful weight restoration for patients whose illness contains features of both ARFID and AN and strategies to overcome these.
Develop questions for future research focused on improving nutritional rehabilitation treatment outcomes for underweight patients with ARFID.

Workshop: Shaping future body image and eating disorder developments in the autistic community

Phaedra Longhurst, PhD Student, School of Psychology and Sport Science, Anglia Ruskin University
Dr. Emily Nimbley, Eating Disorder and Autism Collaborative (EDAC), University of Edinburgh

Abstract: While body image and eating disorder (ED) research has focused on the development of assessment tools and treatment programmes for use among diverse populations (e.g., racialised status, sexual orientations), there is a scarcity of available resources that are developed with autistic population in mind. This is despite accumulating evidence suggesting autistic individuals being at a greater risk for experiencing body image and eating-related difficulties. With autistic individuals found to describe unique body image and ED symptoms and needs, future developments should be informed by autism-led research to meaningfully address limitations in current theory and practice. This workshop will provide an overview of the existing literature that explores body image experiences in the autistic population, and highlight pertinent autism-specific factors of ED symptomatology. The workshop will then discuss how these unique experiences introduce methodological challenges for assessing and treating body image and ED symptoms in this population. Following this, facilitators will draw on theoretical frameworks for participatory-led design, an innovative methodological approach for use among autistic and autism communities. Throughout the workshop, facilitators will use exemplary research to demonstrate adaptations that affirm autistic needs and successfully address existing challenges in body image and ED theory and practice. Facilitators will encourage active discussion and participation using tools that have already supported developments among the autistic community. This workshop was developed in the pursuit of improving participants’ understanding of the variances in body image and ED experiences in autistic individuals, and stimulate ideas for improving access to neuro-affirmative research and practice.

Learning Objectives:

Describe unique factors (e.g., sensory processing) that may result in body image and eating disorder symptoms for the autistic population.
Recognise limitations in current theory and practice for assessing and treating body image and ED symptoms among autistic individuals.
Learn how participatory-led design can be used to develop assessment tools and improve autistic individual’s access to affirmative treatment.

Workshop: Managing a Fraught Comorbidity: Type 2 Diabetes and Eating Disorders

Molly Robbins, BA, Nova Southeastern University
Erin Phillips, MPH, RD, CDCES, Erin Phillips Nutrition
Gregory Dodell, MD, FACE, Central Park Endocrinology
Erin Knopf, MD, CEDS, FAAP, DABPN, VERY | Virtual Eating Recovery for You
Chelsea Levy, MS, RD, CDN, Chelsea Levy Nutrition
Paula M. Brochu, PhD, Nova Southeastern University

Abstract: Eating disorders and type 2 diabetes both present unique health and treatment challenges. The co-occurrence of these conditions is more prevalent than commonly recognized, with eating disorders occurring in an estimated 12-40% of individuals with type 2 diabetes. This intersection creates a unique challenge, where patients often find themselves caught between contradictory treatment approaches from healthcare providers who are specialized in either diabetes or eating disorders, but rarely both. This disconnect results in fragmented care and missed opportunities for early intervention or holistic support. Despite the high prevalence of type 2 diabetes, research and resources predominantly focus on type 1 diabetes. Common approaches to Type 2 diabetes management are rooted in weight stigma, which has documented deleterious effects on health and eating disorder risk, and the recommendations often seem at odds with eating disorder recovery goals. Patients are advised to restrict or eliminate specific foods and food groups in the name of diabetes management. Additionally, they are encouraged to meticulously monitor food labels and glucose readings, which can trigger heightened anxiety and shame about numbers. For higher weight patients, diabetes treatment guidelines prioritize weight loss as the primary goal.This focus on numbers, dietary restriction, and weight loss can create a perfect storm for those at risk of or struggling with an eating disorder. The conflicting recommendations leave both patients and their providers grappling with uncertainty: which path should they follow—the strict "lifestyle management" instructions aimed at diabetes control, or the recovery-based objectives centered on increasing food freedom, promoting intuitive eating, and reducing obsessions with numbers? Keeping these two critical aspects of an individual's health, diabetes care and eating disorder recovery, separate from one another results in a siloed approach, hindering progress and prohibiting the provision of integrated, individualized care that addresses the complex needs of those living with both conditions. In this multidisciplinary workshop, featuring an endocrinologist, dietitian, diabetes educator, pediatrician, and social psychologist, and facilitated by a student with lived experience, participants will gain a deeper understanding of the medical, scientific, and clinical considerations for this comorbidity, from a stigma-informed, Health At Every Size © lens.

Learning Objectives:

Learn the basic science behind type 2 diabetes and common medical interventions.
An understanding of the impact of weight stigma on diabetes-related health outcomes, and why weight normative interventions often fail patients.
Three steps to take when advocating and caring for patients with both an eating disorder and diabetes.

Workshop: Integrating Physical & Occupational Therapy in the Comprehensive Care of Anorexia Nervosa

Chelsea Boyd, PT, DPT, ACUTE Center for Eating Disorders and Severe Malnutrition
Monica Williams, Occupational Therapist, OTD, OTR/L, ACUTE Center for Eating Disorders and Severe Malnutrition
Delaney Wesselink, Physical Therapist, PT, DPT, ACUTE Center for Eating Disorders and Severe Malnutrition
Dr. Philip S. Mehler, Denver Health Medical Center

Abstract: Anorexia Nervosa (AN) is a psychiatric illness that causes a myriad of serious medical and physical complications that adversely affect an individual’s health. While psychological, nutritional, and medical interventions for those suffering with AN have been extensively studied, the role of physical therapy (PT) and occupational therapy (OT) in the treatment of AN is not well studied. The malnutrition of AN leads to sarcopenia and osteoporosis which increase frailty and the risk of fractures and falls. These potential sequelae from AN also hinders a person’s engagement in daily activities thereby further compromising their overall quality of life. This workshop will explore the vital role of physical and occupational therapy in the comprehensive care of treating those with AN. It will be an interactive learning experience for participants to gain practical knowledge in the role and scope of physical and occupational therapy. The workshop will encompass case studies, hands-on engagement in routine PT/OT assessments, and an interactive segment allowing attendees to actively partake in PT/OT interventions specifically geared to people with AN. Moreover, participants will learn when to refer patients to occupation and physical therapy services to enhance collaboration among healthcare professionals, leading to more comprehensive and effective care for individuals with AN on their path to recovery.

Learning Objectives:

Understand the valuable role of physical and occupational therapy in the treatment of AN.
Identify people with AN who would benefit from PT and OT services.
Identify strategies in networking and collaborating with PT and OT professionals.

Workshop: Moving through phases of family-based treatment: Strategies to prevent getting stuck in Phase One

Dr. Cara Bohon, SVP Clinical Programs, Equip Health
Erin Parks, Chief Clinical Officer, Equip Health
Kelly Cai, Senior Data Analyst, Equip Health

Abstract: Although manuals for family-based treatment (FBT) for anorexia nervosa and bulimia nervosa estimate that Phase 1 should last about 10 weeks (10 weekly sessions), Phase 2 lasts about 3 months (6 bi-weekly sessions) and Phase 3 lasts about 4 months (4 monthly session), there are no existing studies that show how long each phase lasts in real world practice. Indeed, even randomized trials of FBT have not reported actual length of each phase in practice during the trials. Length of phases may be important to ensure continued movement through treatment and prevent stagnation. Common dilemmas described in implementation of FBT include transitions to Phase 2 that occur either too quickly or too slowly. In particular, when families are in Phase 1 too long, they are at risk for burnout or treatment fatigue or patients miss out on advancements to independence and engagement in non-eating disorder life events. The FBT manual suggests that transition to Phase 2 should occur when patients are around 90% of their target weight (if they need weight restoration), when meals require no significant struggles, and when binge eating and purging have ceased. Our data from a real-world treatment center providing telehealth FBT for children, adolescents, and young adults with eating disorders showed that 23-24% of patients remained in Phase 1 despite meeting full weight restoration and symptom remission. These patients also remained in Phase 1 through 20 weeks of treatment, about twice as long as recommended by the manual, although explorations of cases revealed that some had begun experimenting with independence despite not fully or formally transitioning to Phase 2. This lack of full transition to Phase 2 as recommended by symptom improvement may be due to clinician or family resistance or both. This workshop will provide an overview of the key decision points clinicians use to move between phases, present results on length of time in each phase in a large real world practice setting, and practice strategies focused on preventing slow transitions given our data highlighting that this was most common.

Learning Objectives:

Describe key decision points for each Phase transition in FBT.
Evaluate when family or clinician is resistant to advancing to next Phase.
Apply strategies to prevent prolonged time Phase 1.

Workshop: Adapting FBT for the Inpatient Medical Unit: Best Practices across Three Children’s Hospitals

Sarah Eckhardt, PhD, Children's Minnesota
Tamara Maginot, Psychologist, UC San Diego Eating Disorders Center and Rady Children’s Hospital San Diego
Alix Timko, Psychologist, Children’s Hospital of Philadelphia
Nicole Cifra, Assistant Professor, Children’s Hospital of Philadelphia

Abstract: Family-based treatment (FBT) is widely considered the first line treatment for eating disorders in children and adolescents. While FBT was initially developed as an outpatient therapy model, it is frequently adapted for use in other settings. Patients with severe medical complications from their eating disorders frequently require initial medical hospitalization. Caregivers are often a captive audience while their child or adolescent is hospitalized and therefore capitalizing on their presence and beginning treatment can be of great benefit. Given the 2024 ICED focus on building connections, this workshop will provide guidance from three leading Children’s Hospitals across the country who are all effectively treating complex eating disorder patients on inpatient medical units. We will present commonalities and differences between the programs on core principles of FBT that are utilized to engage and educate caregivers. Knowledge of best strategies for building connections to transition patients to outpatient providers may be particularly useful for practitioners in both inpatient and outpatient settings, as support and consistency for families to continue FBT after the hospital is crucial. The proposed panel will assist providers in ways to improve treatment outcomes and facilitate a smooth transition in care. Panelists are comprised of physicians, researchers, and clinicians who will each describe strategies to incorporate core FBT principles that guide families through their hospitalization (35 minutes). Several case presentations will then be presented (20 minutes), followed by role plays to discuss the use of various psychoeducational strategies (15 minutes). Finally, workshop members will participate in group discussions and be provided with time to ask questions of each panelist (20 minutes). Attendees will leave with knowledge about various ways to adapt FBT and bridge the connections with outpatient providers and teams.

Learning Objectives:

1. Describe strategies to adapt FBT principles effectively for the inpatient medical setting.
2. Demonstrate core FBT psychoeducational strategies that can be implemented with families from inpatient to outpatient level of care.
3. Identify communication tools for bridging care and building connections from the inpatient to outpatient setting.

SIG Panel: Sharing the Wisdom: Identifying obstacles and navigating challenges in providing effective nutrition

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