Workshop Summary Session 2

Educational Session 2: Concurrent Workshops & SIG Panels
Friday, March 15, 4:00pm - 5:30pm

SIG Panel: From Suffering to Dying: Is there a Middle Ground? A Dialectical Perspective on Terminality and MAiD

Sponsored by the Professionals in Recovery SIG

Dr. Anita Federici, PhD, FAED, York University; The Centre for Psychology and Emotion Regulation
Scout Silverstein, Clinical Curriculum Development Specialist, Project HEAL
Marissa Adams, BS, lived experience researcher and advocate
James Downs
Kym Piekunka, Director, Kym Advocates
Liz Stokes

Abstract: The suffering of those who struggle with long-standing eating disorder symptoms cannot be understated. Regardless of the eating disorder diagnosis, many individuals oscillate between relapse and recovery, face systemic barriers to treatment, have been chronically invalidated, misunderstood, and mistreated, and frequently carry a tremendous sense of hopelessness. Individuals who are critically unwell as a result of an eating disorder require better attention to the dignity, respect, and ethical care they deserve. At the same time, discussions and research regarding how best to support those from whom common ED approaches to treatment have not worked are sparse. In spite of great strides over the past three decades, the eating disorders field continues to grapple with moderate to low treatment outcomes, pervasive problems with a lack of accessible, diverse, and equitable care, and poorly defined definitions of the recovery process. The gap between need and knowledge is substantial.

Some of the most prominent efforts to address part of this gap include the proposed criteria for “terminal anorexia” and the increasing accessibility for medical assistance in dying (MAiD). At the same time, others in the field - in particular those with lived and living experience have challenged whether these proposed solutions offer patients the ethical care and therapeutic optimism they need since recovery cannot definitively be ruled out. These divergent perspectives raise important issues about how our field defines, conceptualizes, and responds to complex and longstanding EDs often compounded by co-occurring mental health conditions.

Thus, this panel brings together a highly engaged group with diverse perspectives on the nuances of supporting those in critical stages of illness. Our panel represents diverse perspectives with many panelists occupying multiple roles: bioethicist, registered nurse, attorney, clinical psychologist, advocate, public health scholar, peer support provider, and experts by experience. We will discuss current controversies and provide novel options for those who are most likely to be considered for MAiD.

Learning Objectives:

Describe how core ethical principles help guide discussions of MAiD for eating disorders (e.g., beneficence, nonmaleficence, autonomy, and justice).
Explain how a dialectical approach can create space for novel and under-explored options for critically ill individuals.
Critically explore the use of terminology, terms, and definitions in an effort to foster effective communication, facilitate understanding, and promote collaboration across diverse disciplines and cultures.

SIG Panel: The Impact of Weight Stigma on Eating Disorder Treatment and Outcomes

Sponsored by the Weight Stigma SIG & Social Justice SIG and the Professionals in Recovery SIG

Shruti Kinkel-Ram, Doctoral Candidate, Miami University
Mari Thomeczek, University of Kansas
Bek Urban, Equip
Sarah Sullivan, University of Denver
Erin Harrop, Assistant Professor, Denver University
Molly Robbins, Nova Southeastern University

Abstract: People who experience weight stigma are more likely to have an eating disorder (ED), but less likely to seek treatment. Further, individuals who attribute their ED to anti-fat messaging show more severe symptoms at treatment admission. However, weight stigma persists in healthcare settings, resulting in barriers to care. This 90-minute panel, co-sponsored by the Weight Stigma and Social Justice SIG and Professionals in Recovery SIG, seeks to elucidate the complex relationships between weight stigma and ED course and outcomes. To begin, Author 1 will provide a general overview of the association between weight stigma and ED cognitions and behaviors, by highlighting findings from a recent systematic review of N=218 studies. Findings revealed a consistent relationship between higher weight stigma and more ED cognitions and behaviors, with some exceptions. Next, Author 2 will present findings from a linear regression study of college-students with a probable ED diagnosis (N=278; M age= 23.7, 75.5% women, 16.5% men, 7% other gender, 11% Asian, 4.7% Black, 13.3% Hispanic, 81.7% White, 7% other race) which found that self-perceived everyday weight discrimination was positively associated with ED-related psychiatric impairment as well as interest in a mobile-based guided self-help ED treatment. Third, Author 3 will share findings from a qualitative analysis of the role of dieting in ED course, in a sample of 39 diverse patients with atypical anorexia (23% trans, ages 18-74, 28% non-white, 64% LGBTQ). Findings revealed a common narrative of: 1) experiencing dieting and body dissatisfaction from young ages, 2) initiating dieting (often at the impetus of parents or providers) to fix their problematic bodies, 3) dieting developing into obsessions, disordered behaviors, and EDs, 4) dieting masking recognition of the ED, and 5) dieting triggering ED relapse. Finally, Author 4 will present results from an experimental study examining the impacts of clinician body size on client perceptions of ED therapists. Participants (N = 210) were randomized to one of two conditions where they either view a manipulated photo of a therapist with thin privilege or larger-bodied therapist. These talks will use empirical research to illustrate how weight stigma impacts ED courses and treatment, and will comprise the first 45 minutes. Then, co-chairs will facilitate an interactive discussion synthesizing these talks in the final 45 minutes.

Learning Objectives:

Identify 3 reasons why a weight inclusive approach to healthcare is an ethical, effective for working with patients with eating disorders.
Learn three ways weight stigma can negatively impact eating disorder treatment course and treatment.
Discuss strategies to off-set the negative impact of weight stigma on eating disorder treatment outcomes.

SIG Panel: Developing Standards for Neuropsychological Assessment in Individuals with Eating Disorders

Sponsored by the Assessment and Diagnosis SIG & the Neuropsych SIG

Jiana Schnabel, B.S., Temple University
McKenzie Miller, Predoctoral Psychology Intern, Roger's Behavioral Health
Lisa M. Anderson, University of Minnesota
Dawn Eichen, UC San Diego
Kelsey Hagan, Assistant Professor, Virginia Commonwealth University
Stephanie Miler, The University of Melbourne
Elysa Roberts, The University of Newcastle

Abstract: In the past decade, there has been a growing emphasis on investigating inefficiencies in neuropsychological functioning among individuals with eating disorders (ED). Numerous neuropsychological tests aim to measure the same constructs (e.g., cognitive flexibility, central coherence, inhibitory control, etc.). However, there is a lack of consensus regarding the most appropriate neuropsychological assessments to use – including questions regarding whether or not different assessments are more suitable for certain contexts or questions. There is also inconsistency in the scores or metrics used from a variety of assessments as well as in the interpretation of outcome variables from various assessments as indicators of (inefficiencies in) cognitive functioning. The proposed panel will assist researchers and clinicians in better understanding the advantages and limitations of using different neuropsychological assessments and ways to reduce confusion and improve the communication of neuropsychological results to patients, trainees, and colleagues. To foster a rich and constructive discussion on this topic, the panel will include researchers and clinicians across various career stages and areas of expertise (e.g., lived experience perspective, researchers focusing on cognitive and psychological factors of EDs, developmental neuropsychology in EDs). Specifically, we will cultivate a discussion focusing on the following topics: 1) What types of neuropsychological assessments are most commonly used in eating disorder research and treatment, and what aspects of cognition/executive functioning do they measure? 2) What are the benefits and drawbacks associated with various assessment tools (e.g., self-report measures versus neuropsychological tests)? 3) What assessments are more suitable for research, and which are better used in clinical practice? 4) What assessments are appropriate for pediatric versus adult populations? 5) How can the field enhance clarity in conveying neuropsychological results (e.g., consistency in what neuropsychological scores are reported and how neuropsychological results are communicated to patients, researchers, and the general public)?

Learning Objectives:

Describe the types of neuropsychological assessments most commonly used in eating disorder research and treatment and what aspects of cognition/executive functioning they measure.
Understand the benefits and drawbacks of various neuropsychological assessment tools.
Describe the steps the field can take to enhance clarity in conveying neuropsychological results to patients, researchers, and the general public.

SIG Panel: Challenges and recommendations for conducting pilot eating disorder interventions in graduate school

Sponsored by the Early Career SIG

Jordan Schueler, Doctoral Student, Texas A&M University
Brenna Williams, Doctoral Student, University of Louisville
Maria Nicula, Doctoral Student, McMaster University
Blair Burnette, Assistant Professor, Michigan State University
Brook Bennett, Assistant Professor, Clemson University
Dr. Ruth Striegel Weissman, Wesleyan University

Abstract: Decades of research demonstrates widespread variability in treatment efficacy and retention for “gold standard” treatments for eating disorders (EDs). Conducting more high-quality pilot studies stands to benefit the greater patient and clinical community. Pilot intervention trials are considered smaller-scale studies that test the feasibility, acceptability, and preliminary effectiveness of novel interventions. Graduate students are in a unique position to implement pilot studies due to their focused research endeavors in graduate school, and access to training in current and up-and-coming clinical and statistical methods. Yet, there remains a lack of resources and guidance for conducting this type of research as a graduate student. Therefore, the Early Career SIG is proposing a panel to address and discuss common obstacles and recommended solutions for students planning to conduct pilot intervention studies in the treatment of EDs during their tenure in a graduate program. The four panelists will cover four identified stages of completing a pilot intervention study. Ms. Maria Nicula will discuss the necessary steps for designing a pilot study, including being mindful of the limited ED-specific training and funding resources offered at the graduate student level. Dr. Brooke Bennett will cover specific considerations and challenges with recruiting individuals with EDs given the low prevalence of EDs, the student’s access to clinical populations, and limited time-frame for the study, dependent on the student’s status in their program and plan for graduation. Dr. Blair Burnette will present solutions for issues that arise related to intervention implementation, including risk assessment with the Institutional Review Board, attrition, and conducting virtual interventions. Dr. Ruth Striegel Weissman will speak to the expectations and recommendations for students to publish findings in a high-impact, peer-reviewed academic journal. Finally, Ms. Jordan Schueler and Ms. Brenna Williams will serve as co-chairs for this panel, and will provide an overview of each section, moderate discussion, and provide relevant examples from their own experiences in graduate school. We intend for the discussion portion of this panel to stimulate meaningful conversation between graduate students, early career researchers, and faculty advisors wishing to stay abreast of current complexities and recommendations for mentoring a student conducting interventions research.

Learning Objectives:

Describe the realities and complexities of conducting pilot intervention studies for eating disorder populations in graduate school.
Address common challenges and limitations faced by graduate students in pilot study participant recruitment, implementation, and retention.
Identify considerations and advice for preparing a manuscript based on a pilot intervention for publication in a peer-reviewed, academic journal.

SIG Panel: Ethical and practice implications in the adapt/adopt conundrum in private practice settings

Sponsored by the Private Practice SIG & the Nutrition SIG

Lauren Muhlheim, PsyD CEDS-S, FAED, Eating Disorder Therapy LA
Abby Sarrett-Cooper, Private Practice Clinician, Partners in Counseling
Jennifer Campbell, DBT-Eating Disorder Staff Clinician, Center for Evidence Based Treatment Ohio
Ellie Benner, Private Practice Clinician, Main Line Center for Eating Disorders
Therese Waterhous, Owner & Founder, Willamette Nutrition Source
Lucene Wisniewski, PhD, FAED, Chief Clinical Officer, Founder, Center for Evidence Based Treatment-Ohio

Abstract: Evidence-based treatments are typically developed within an institutional academic setting and researched within highly controlled conditions. Private practice clinicians often find that the parameters of their work environments, such as physical context, client selection, clinical presentation, etc. differ from the treatment manuals and/or trainings offered by developers, thus requiring providers to adapt these treatments for various constraints. This panel aims to address the inherent need to share effective strategies and creative solutions among private practice clinicians in navigating the dilemma of adopt versus adapt for specific treatment models. This workshop will focus on the most commonly used evidence-based treatments in outpatient eating disorder care (CBT-E, DBT, FBT and Nutritional support). Experienced clinicians will share several translational concerns they have experienced in their practice and then offer strategies for at least one of these concerns. The remaining concerns will be the focus of discussant dialogue and Q&A.

Learning Objectives:

Identify discrepancies between implementing evidence-based treatment models as established vs in “real-world” private practice settings.
Identify solutions to bridge said discrepancies when working directly with clients and families to maintain the integrity of the chosen evidence-based practice, while staying attentive to client and family vulnerabilities.
Increase validation of clinician experience and competence in adapting treatment models for complex clinical presentations.

SIG Panel: Mapping the Landscape: Current Global Trends in Eating Disorder Epidemiology

Sponsored by the Epidemiology and Public Health Practice SIG

Monique Santoso, B.A., Stanford University
Ariel Beccia, Postdoctoral Fellow, Boston Children's Hospital

Abstract: A growing body of evidence indicates that the epidemiology of eating disorders has shifted dramatically during recent years, including with respect to an increased population burden and exacerbated social disparities in risk. These changes can likely be attributed to the influence of major global events such as the COVID-19 pandemic, as well as longstanding structural inequities and social determinants of health, and may be especially pronounced in Global South countries that have been historically neglected within the eating disorder literature. In this Epidemiology & Public Health Practice SIG Panel, we will review these emerging trends in eating disorder epidemiology, with a focus on highlighting implications for treatment, prevention, and research. To stimulate a rich and constructive discussion, panelists will comprise researchers from varying disciplines and areas of expertise (e.g., public health, social psychology), across a range of career stages. Topics that will be addressed include: (1) recent trends in global eating disorder prevalence and incidence; (2) the changing nature of eating disorder epidemiology within Global South regions such as Latin America, Southeast Asia, African, and the Caribbean; and (3) the macro-level factors driving these patterns, including (but not limited to) COVID-19, the climate crisis, structural forms of discrimination, and the growing influence of social media. Panelists will also shed light on some of the methodological considerations and challenges associated with conducting such cross-cultural and multilevel epidemiologic research on eating disorders. The second half of our session will be dedicated to discussions between the panelists and the audience with the goals of identifying future directions in multidisciplinary eating disorders research and exploring mechanisms for effective policy-oriented interventions to help address the discussed epidemiologic patterns and disparities.

Learning Objectives:

Describe the recent trends in global eating disorder epidemiology, particularly among understudied countries and populations in eating disorders research.
Understand the role of macro-level sociopolitical factors, such as the COVID-19 pandemic, the climate crisis, structural racism and sexism, and social media, on eating disorders prevalence and incidence.
Identify methodological considerations and challenges associated with conducting epidemiologic eating disorders research, and strategies to address them.

SIG Panel: From Design to Delivery: Research in Tech-Driven Eating Disorder Care

Sponsored by the Technology & Innovations SIG

Caitlin Shepherd, PhD, Within Health
Jorge Palacios, Chief Science Officer, Bright Therapeutics
Christina Ralph-Nearman, Chief Innovation Officer/Founding Member, Awaken Digital Health Solutions; ; Assistant Research Professor, University of Louisville
Rachael Flatt, Center of Excellence for Eating Disorders at UNC Chapel Hill, Researcher at the Binge Eating Genetics Initiative
Dr. Sarah Barakat, InsideOut Institute, University of Sydney,

Abstract: In the rapidly evolving landscape of eating disorder treatment, the Technology and Innovations Special Interest Group (SIG) convenes to harness the potential of emerging technological interventions. This panel discussion explores the pivotal role that research plays in the development, real-world implementation, and ongoing exploration of digital therapeutics. First, Rachael Flatt will cover the development and initial findings of the Binge Eating Genetics Initiative, where novel analytic approaches are being tested on a digital eating disorder intervention. Specifically, results from the application of dynamical systems modeling of disordered eating behaviors (binge eating and compulsive exercise) will be presented as conceptual foundations for just-in-time adaptive interventions. Transitioning from conceptualization to real-world application, the panel’s second presentation will delve into the early-stage start-ups realm. Dr. Christina Ralph-Nearman will share her experience developing and piloting digital therapeutics with clinician and patient input as well as conducting foundational studies to implement and validate the effectiveness of innovative digital tools in everyday life. Culminating the panel, the final presentation will highlight how an established company incorporates research into their product's nuanced performance. Dr. Jorge Palacios will focus on understanding variances in user needs, determining return on investment, and other paramount outcomes, demonstrating that continuous research remains vital to ensure innovation and scale. The thread of the conversation ties into the SIG’s objectives, emphasizing collaborations across academia, industry, and healthcare institutions. Aligned with this goal, the panel will engage a broad audience by providing illustrative research case examples as well as outlining criteria for clinicians and consumers to use when evaluating the evidence base behind tech-based products. Following the presentations, participants will have the opportunity to engage in facilitated small-group discussions on topics such as common challenges and potential solutions across each research stage, barriers and facilitators of digital therapeutic uptake, and avenues for future innovation and exploration. As technology spearheads the future of eating disorder treatment innovations, this panel magnifies the indispensable role of rigorous research, collaboration, and iterative evaluation at each developmental phase.

Learning Objectives:

Differentiate the three stages of digital therapeutics research presented by discerning their primary goals and contributions.
Identify appropriate research methodologies for each stage based on their respective goals.
Assess the strength of evidence underlying claims made about digital therapeutic products.

Workshop: Empowering Youth in Eating Disorder Advocacy: Establishing a Youth Advisory Board

Pari Patel, A.S., A.A., Harvard STRIPED (Strategic Training Initiative for the Prevention of Eating Disorders)

Abstract: More than ever, organizations and advocates in health policy for eating disorders are acknowledging the profound understanding youth have of their own lives and challenges related to eating disorders. Recognizing the potential of these young voices, especially those directly impacted by eating disorders, becomes essential in reshaping the policy landscape for comprehensive eating disorders prevention and treatment. Building a vibrant Youth Advisory Board can amplify youth voices and provide richer, more authentic insights in the field of eating disorders advocacy. Successful integration of youth into policy advocacy necessitates not just knowledge of policy-making but also nurturing relationships with the young individuals who are directly influenced by these policies and eating disorders. This empowers them with essential skills like civic engagement, effective communication with policymakers, and community organization. For this workshop, participants will collaborate with youth from the Strategic Training Initiative for the Prevention of Eating Disorders Youth Corps (STRIPED, www.hsph.harvard.edu/striped). With their focus in policy-focused research and translation, STRIPED's faculty and youth will guide attendees in effectively engaging with youth in policy advocacy. The session will begin with facilitators highlighting key principles and proven methods of integrating youth into policy advocacy, using insights from related fields. Following this, participants will be introduced to best practices and strategies that actively captivate youth in order to weave them into organized advocacy. Activities such as the emulation of interaction between adults and the youth advisory board will enable attendees to recognize the influential capacity of young individuals. This will be underlined by principles championed by youth advocates, ensuring genuine representation. A pivotal component of this workshop will be the experiential learning through youth-curated activities. These activities, aimed at tailoring approaches to the specific needs of participants, will demystify ethical apprehension of youth in advocacy. Attendees, throughout the workshop, will receive guidance on how to implement a Youth Advisory Board. With a blend of engaging discussions and evidence-driven active learning exercises, participants will be equipped with the knowledge, confidence, and strategies to meaningfully include youth in their eating disorder advocacy work.

Learning Objectives:

Design an effective youth advisor interview process to ensure alignment with organizational goals.
Demonstrate understanding of the dynamics and operations of a Youth Advisory Board, and strategize for long-term engagement and participation through role-play activities.
Address potential challenges and devise solutions to maintain enthusiasm and productivity within a Youth Advisory Board.

SIG Panel: Identifying, Diagnosing, and Treating Eating Disorders in the Primary Care Setting

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