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.