Announcement: Intensive Program for Adults with Eating Disorders Now Opened in the NY-Metro Area!

by Tara Deliberto, Ph.D.

I'm very excited to announce the opening of a new intensive program from adults with eating disorders at NewYork-Presbyterian Hospital!  This program runs from 8:30am-3:00pm, Monday-Friday, and provides adults with eating disorders the opportunity to eat three times per day with the support of caring and well-trained behavioral specialists.  In addition to meal and snack support, patients receive individualized care while having access to a host of groups focusing on goals such as establishing understanding and use of cognitive behavioral therapy skills, mindfulness practice, assertiveness, and the regulation of one’s emotions.   Taken together, the services offered to our patients - including meal and snack support, individual therapy, family therapy, and group sessions - foster both mental and physical recovery from disabling and life-threatening eating disorders.   


Although our eating disorders partial hospitalization program (ED PHP) is new, New York-Presbyterian Hospital has served the community by treating patients in both inpatient and outpatient settings for many years. Our specialized eating disorders inpatient unit helps people psychologically recover from eating disorders, while benefiting from close medical monitoring of physical symptoms resulting from food restriction & avoidance, purging, laxative use, and other eating disordered behaviors.  Additionally, we have outpatient services where people with eating disorders can see licensed mental healthy professionals for 1-2 sessions per week.  Until now, however, patients with any form of insurance in the NY-Metro Area have not been afforded the opportunity to have an intermediate level of care in a hospital setting in which support, psychological services, & medical monitoring are provided consistently throughout the week.


In this new eating disorders partial hospitalization program (ED PHP), patients are treated & supported by staff from the disciplines of nursing, social work, psychology, nutrition, & psychiatry, who work together to help people recover both mentally & physically from the effects of the eating disorder.  Leadership of this new program will include myself, Tara Deliberto, Ph.D., Assistant Professor of Clinical Psychology in Psychiatry at Weill Cornell Medicine, and Director of the Eating Disorders Center’s Partial Hospitalization Program at New York-Presbyterian Hospital, as well as Evelyn Attia, MD, Professor of Psychiatry at Columbia University Medical Center, Professor of Psychiatry at Weill Cornell Medical College, Director of the Eating Disorders Research Program at the New York State Psychiatric Institute, and Director of the Columbia Center for Eating Disorders at Columbia University Medical Center.   


For more general information about the Eating Disorders Center: http://www.nyp.org/psychiatry/services/center-for-eating-disorders.  More info on the ED PHP will be up soon!

 

A BIT MORE ABOUT BITE

In Comprehensive BITE Stage 1, BITE Family Therapy and BITE Group were thoughtfully created to compliment each other.  During Stage 1 BITE Family Therapy, the therapist teaches parents to take control of food responsibilities.  Parents also learn to coach the patient in eating meals/snacks and help them through difficult eating disorder urges.  Stage 1 BITE Family Therapy terminates when the patient has reached weight restoration and stabilization.  Although this is likely to improve the patient's cognitive and emotional functioning, the addition of Stage 1 BITE Group is intended to expedite this process.  Stage 1 BITE Group has been designed to specifically facilitate acceptance of parental control over food, provide skills training, and increase recovery behaviors (as defined in the BITE Handouts) early in treatment.

With improved physical and psychological health at the completion of BITE Stage 1, the timing is ripe for the introduction of CBT coping skills to support the patient’s process of reclaiming independence.  Stage 2 BITE Family Therapy is focused on gradually and systematically handing over food responsibilities - called Earned Freedoms in BITE - to the patient.  Especially for patients scared of the eating disorder returning, this process can be very anxiety provoking.  As such, Stage 2 BITE Group is administered alongside Stage 2 BITE Family Therapy to impart coping skills.  While Stage 1 BITE Group primarily focuses on traditionally "third wave" acceptance and mindfulness strategies, Stage 2 BITE Group focuses mostly on the development of CBT skills (e.g. thought disputation).  Skill building in Stage 2 BITE Group also lays the necessary groundwork for exposure exercises in Stage 3.     

After the patient’s weight is stable, eating disorder behaviors have significantly decreased, and coping skills are in place, a transition to BITE Stage 3 is made.  In this crucial final stage of BITE, the patient receives individual therapy twice per week.  One type of session fosters self-directed eating, while the other aims to improve body image.  In the former type of individual therapy, patients are guided to eat regularly (three meals and two snacks) and according to their own appetitive cues of hunger and fullness.  We call this Regular and Appetitive Eating or "RAE."  Alongside RAE, the patient receives Body Acceptance and Exposure or "BAE."  BAE includes a series of body size/shape/weight acceptance and exposure exercises (e.g. imaginal exposure of seeing a weight a few pounds higher on the scale) that facilitate anxiety reduction.  This type of body image work is saved until Stage 3 because the patient’s weight has been restored and stabilized at this point in treatment.  Lastly, throughout both RAE & BAE in Stage 3, self-sufficiency and relapse prevention are underscored.

Using Cool Temporary Tattoos in Therapy

by Tara Deliberto PhD

Decreasing eating disorder behavior is a main part of any treatment for anorexia nervosa, but in BITE, we also focus on increasing recovery behavior.  Recovery behavior can be anything from actively using coping skills to eating an entire meal without having an emotional outburst.  Providing reinforcement to adolescents with eating disorders is an important part of increasing recovery behavior in BITE.   But coming up with ideas for reinforcers can be tough!  Sure, non-verbal cues like smiling or providing verbal encouragement can be tremendously helpful, but what can the adolescent work for in treatment?  Just working towards "getting better" isn't going to cut it with this crowd.  Working towards obtaining something enticing can be a powerful motivational tool in eating disorder treatment.  The problem is that tangible rewards for teens can become expensive pretty quickly.  

So, what about the really cool temporary tattoos that Tattly makes?  Those seem like a good idea, and not just because they're affordable.  Any Tattly would make a good reward because so many adolescents love them.

Beyond just making a good reward, Tattlys can be used more artfully in treatment as well.  Because most eating disorders are accompanied with poor body image, simply placing any cool temporary tattoo on a body part judged to be "disgusting" by the patient can begin to create a new mental association with that area.  The idea is that while that body part used to be negatively judged, the addition of a Tattly would now add a positive judgement.  And perhaps more importantly, if an adolescent is prone to avoiding looking at that body part, having a cool temporary tattoo on the area might facilitate a decrease in the eating disorder symptom of body avoidance.  In addition to placing Tattlys directly on negatively judged body parts, the Tattly intervention can also be helpful more broadly to patients with eating disorders.  Below are examples of how Tattlys can be used in conjunction with BITE.  

Specific to Stage 1 BITE:

Specific to Stage 2 BITE:

Specific to Stage 3 BITE

 

We some of the ideas in this post inspired you!  Keep us posted on how your intervention with Tattlys went over.  Please feel free to leave comments for us on this post.