Clinical Training & Research Training Day

Clinical Teaching Day 2017
Wednesday, June 7 from 2:00 PM - 6:00 PM

CTD 1 Neuroscience: Using New Understandings of Brain and Behavior to Develop More Effective Treatments for Eating Disorders Meeting Hall IV, Second Floor

Laura Hill, PhD, FAED1, Walter Kaye, MD, FAED2, Christina E Wierenga, PhD2, Stephanie Knatz Peck, PhD2, Janet Treasure, OBE, MD, PhD3, Kate Tchanturia, PhD, FBPS, FAHE, FAED3
1The Center for Balanced Living, Columbus, Ohio, USA; 2UCSD Eating Disorder Residential & Treatment Program, San Diego, California, USA; 3King’s College, London, United Kingdom;

Purpose: Anorexia nervosa (AN) is a severe, biologically based brain disorder with significant medical complications requiring new, effective treatments to interrupt the persistent course of the illness. AN treatment attempts have been diverse, however, evidence shows that impact is weak and effects are generally small. This workshop will integrate current neurobiological AN research from diverse perspectives into a shared goal that translates into various forms of clinical practice.

Subject Samples: Adolescent and adult AN cohorts in partial hospital and intensive outpatient eating disorder programs from two counties and three treatment sites.

Methods: Translational models will be described that address cognitive and emotional domains integrated into a cognitive remediation manual for clinical practice. In addition, a 5-day, 40 hour AN treatment targeting AN temperament that integrates neurobiological research will be described interactively. A manual will be introduced.

Results Obtained: Data, both quantitative and qualitative, will be shared on each treatment approach and manual development.

Summary: Participants will be encouraged to participate in both discussions and clinical tools involvement in treatment programs.

Objectives:

1. Integrate current neurobiological anorexia nervosa research into various forms of clinical practice.
2. Describe how neuro-progression changes the form and content of anorexia nervosa.
3. Discuss how therapists can integrate research findings on cognitive and emotional processing with patients to help in recovery.
4. Introduce preliminary data suggesting reward, inhibition, and salience in ED improve treatment response.
5. Apply recent imaging data, on interoceptive processing and the mismatch between anticipated and actual experience, to a 5-day eating disorder treatment structured environment that reduces internal "noisy" signals that evoke anxiety and avoidance.
6. Summarize how the above research findings are integrated into a 5-day ED treatment, involving multifamily/supports with adults and adolescents, will be detailed in an interactive electronic text.


CTD 2
 Therapy: Integrating Family Based Treatment with the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders: a novel treatment for Avoidant Restrictive Food Intake Disorder 
Meeting Hall V, Second Floor

Julie Lesser, MD1, Sarah Eckhardt, PhD2, Daniel LeGrange, PhD, FAED3, Jill Ehrenreich-May, PhD4   
1Center for the Treatment of Eating Disorders, Minneapolis, Minnesota, USA; 2Children’s Hospitals & Clinics, Minneapolis, Minnesota, USA; 3University of California, San Francisco, California, USA; 4University of Miami, Coral Gables, Florida, USA

With the addition of Avoidant Restrictive Food Intake Disorder (ARFID) to the broader DSM-5 category of Feeding and Eating Disorders, increasing numbers of young patients are presenting for treatment of this condition. Patients with ARFID appear to fall into several sub-categories including those with: lifetime picky eating, selective eating and an Autism Spectrum disorder, selective eating in the context of comorbid anxiety conditions, and selective eating in patients with a medical condition and fear of eating due to worries about pain. This workshop will present an integrated treatment approach that combines an adapted form of family based treatment (FBT) for patients with ARFID, together with the Unified Protocols for the Treatment of Emotional Disorders in Children and Adolescents (UP-C/A), a manualized, transdiagnostic cognitive behavioral treatment. The UP-C/A is well suited for all categories of ARFID as it includes modules on mindfulness, flexible thinking, avoidance, and interoceptive and situational exposures. This workshop will demonstrate how to deliver this integrative approach by focusing first on nutritional stabilization and weight regain, using principles of FBT. Role plays will be used to highlight the differences when using FBT for ARFID patients. An overview of the UP-C/A will be presented with interactive exercises to show key modules and techniques used in treating young patients with ARFID. The workshop will support discussion of treatment for patients with different categories of ARFID, and will include a detailed discussion of the use of rewards for behavior change in patients with ARFID.

Following the training, participants will be able to:

1. Describe adaptations of Family Based Therapy (FBT) for ARFID.
2. Demonstrate key interventions from the Unified Protocols for the Treatment of Emotional Disorders in Children and Adolescents (UP-C/UP-A) to treat anxiety and avoidance in patients with ARFID.
3. Understand the protocol for clinician decision-making when combining strategies from both FBT and UP-C/A with youth presenting with varied clinical challenges associated with ARFID.



CTD 3
 Therapy: Binge Eating Disorder – State of the Art of Current Treatment Strategies 
North Hall, Second Floor

James E. Mitchell, MD, FAED
Neuropsychiatric Research Institute, Fargo, North Dakota, USA

This session will review the current state of knowledge regarding the treatment of those with binge eating disorder. The literature will be reviewed, and a number of areas will then be addressed: 1.) Psychotherapy approaches, with an in depth session by session presentation of a CBT approach, the manual for which will be provided to interested participants after the conference by email; 2.) Pharmacotherapy approaches, targeting binge eating and mood, and when appropriate weight loss for those patients who are also obese; 3.) The use of bariatric surgery for those that are severly obese; 3.) A brief review of medical complications and medical evaluation for those who are normal weight, overweight and obese; 4.) Practical recommendations for individual patients based on binge eating status, mood disorders, other comorbidities, and weight. Discussion will include case discussions and suggestions/questions from participants.

1. Participants will be able to discuss the currently available, empirically supported psychotherapies for those with binge eating disorder.
2. Participants will be able to discuss the currently available, empirically supported pharmacotherapies for those with binge eating disorder.
3. Participants will be able to discuss when bariatric surgery should be considered in the treatment of those with for binge eating disorder.
4. Participants will be able to discuss the medical complications and medical evaluation for those with binge eating disorder.
5. Participants will be able to discuss the important key elements of CBT for those with binge eating disorder.



CTD 4
 Therapy: Treatment of EDs in Males and Ethnic Minorities:Cultural and Gender Tailoring
Terrace 1, Second Floor

Mae Lynn Reyes-Rodriguez, PhD1, Arnold Andersen, MD, FAED2   
1Neurosciences Hospital, University of North Carolina, Chapel Hill, North Carolina, USA; 2Iowa City, Iowa, USA

Eating disorders (EDOs) have been inaccurately stereotyped as a disorder of white females. Therefore, most of the treatments have been developed primarily for Caucasians and females. However, the literature of EDOs among males and diverse populations has increased significantly during the past years. It is clear that EDOs do not discriminate by gender, race/ethnicity, or age. Providing culturally tailored treatments that appreciate the culture, context, language and gender differences is essential to reduce health disparities. With the increasing recognition of diversity in prevalence and presentation of disordered eating behaviors comes a need for understanding the etiology, course, treatment and specific needs for males and people who self-define themselves as being members of diverse groups who also have eating disorders. The goal of this clinical workshop is to provide the skills necessary for clinicians who work with males and culturally diverse populations, appreciating how these differences alter the origin, presentation, clinical course, and treatment. The specific objectives are:

1. understand the differences in the internal and external psychosocial and developmental milieu of males and diverse populations compared to Caucasian females;
2. discuss the differences in presentation of the eating disorder symptoms in males and in culturally diverse populations;
3. identify differences in the approach to treating males and patients from diverse cultural backgrounds with eating disorders and,
4. identify the appropriate assessment protocol to be used with males and diverse populations.



CTD 5
 Medical: Medical Complications of Anorexia Nervoxa, ARFID and Bulimia, and Their Treatments
 Terrace 2, Second Floor

Phil Mehler, MD, CEDS, FACP, FAED
Eating Recovery Center, Denver, Colorado, USA

There are many serious medical complications associated with anorexia nervosa and bulimia. This presentation will address these complications and their treatments. It will also deal with how to recognize when a patient needs a higher level of care for ongoing management of medical issues. There are also many complications associated with attempts to discontinue the purging behaviors associated with self-induced vomiting, diuretic and laxative abuse. These serious, and often difficult to manage, complications include, severe edema, electrolyte and acid-base abnormalities, gastrointestinal and cardiovascular-related complications and those which adversely affect body image. Some of these complications, or the memories thereof, often impede the bulimic patient’s attempts to successfully “detox” from harmful purging behaviors and results in these patients reverting back to purging behaviors. A description of the medical complications associated with anorexia nervosa, ARFID and bulimia and with attempts to discontinue the different modes of purging, and their treatments, embedded in evidenced case-based vignettes, will be presented in an understandable and clinically salient manner.

Learning Objectives:

1. Identify medical problems related to bulimia nervosa, and how to manage them
2. Identify medical problems related to anorexia nervosa, and how to manage them
3. Recognize when a patient needs a higher level of care for ongoing management of medical problems

Research Training Day 2017

Research Training Day Club E, First Floor

Stephen Wonderlich, PhD, FAED1, Ross Crosby, PhD, FAED1, Markus Moessner, PhD2   
1Neuropsychiatric Research Institute, Fargo, North Dakota, USA; 2Center for Psychotherapy Research, University Hospital Heidelberg, Heidelberg, Germany

The aim of this workshop is to provide a comprehensive review of the critical steps involved in the planning, preparation, conduct, and publication of quantitative eating disorders research. The topics to be addressed in this workshop include: (1) formulating research questions; (2) designing your research study; (3) choosing assessment measures for your study; (4) regulatory issues, including dealing with Institutional Review Boards, (5) data collection and management; (6) statistical analysis and interpretation; and (7) manuscript preparation. The presenters will provide overviews of each of the areas, as well as supplemental materials with additional information. Ample time will be provided for question and answer sessions. Attendees will be encouraged to discuss their own research projects.