At Koru Spring, we understand that no two people will experience an eating disorder the same way, and tailor our treatment plans to each resident and their recovery goals. Oftentimes techniques and tools from various therapeutic modalities can be used to create a treatment plan that is ever evolving to match the personal growth, goals, and recovery process of the individual.
The treatment modalities used by our therapists include: Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), and Dialectical Behavioral Therapy (DBT).
Individual, group, and family therapy are all utilized at Koru Spring. Experiential and recreational therapies are also an important part of the recovery process and Koru Spring offers a wide range of options that our residents can explore.
Psychological therapy for eating disorders tends to focus on helping the resident gain insight into their thoughts and feelings so that they can develop a healthy relationship with food and their body. The main goal is usually to minimize eating disorder behaviors and involves developing healthy coping mechanisms to assist the person in maintaining their recovery. Evidence supports that some of the most effective psychological treatments for eating disorders include:
Acceptance and Commitment Therapy (ACT) is a type of therapy that places the emphasis on changing your actions and behaviors rather than on analyzing thoughts and feelings. It is incredibly effective in the treatment of eating disorders.
ACT has a strong mindfulness component. Mindfulness allows for uncomfortable and unpleasant emotions and feelings to exist without a need to “do something” about them and places importance on living in the present moment, rather than trying to change it. ACT emphasizes meaningful social connections, being present in the moment and accepting that moment for what it is.
One of the key goals of ACT is to promote and build psychological flexibility. Greater psychological flexibility allows residents to apply new, healthy coping mechanisms to difficult situations. ACT also considers the person’s values and incorporates them into the therapeutic process. Acceptance and commitment therapy processes can include (but are by no means limited to):
- Developing mindfulness strategies to help people to be more present in their day-to-day lives
- Investigating values and what matters most to the individual
- Finding ways to deepen social connections
- Committed action and learning how to break down larger goals into more manageable and achievable steps
- Understanding how to observe oneself without judgement
Cognitive Behavioral Therapy (CBT) helps the person to understand the connection between their thoughts, feelings and behaviors. Focuses for treating eating disorders may include challenging, reframing, or modifying thoughts and feelings around body image, eating and self-worth and developing healthier coping behaviors. Treatment plans often include (but are not limited to):
- Psychoeducation by the therapist to help the individual understand their eating disorder (such as what may have caused it, what the physiological consequences are and other research or theory that is relevant). This process can help residents rationalize both their experiences with their eating disorder and their treatment plan.
- Self-reports or journaling by the resident to record when and what they eat and associated feelings and emotions. This can be an insightful experience and help the person to understand their triggers and patterns.
- Identifying and challenging thought patterns. This involves engaging in talk-therapy and working with a therapist to identify negative thought patterns that are contributing to their disordered eating habits and challenging these. The goal is to help the individual to adopt more positive or neutral attitudes and beliefs.
- Development of coping techniques, such as relaxation, disrupting negative thought patterns or problem-solving to focus on a solution, are an integral part of CBT. Regaining control over thoughts and behaviors is crucial to treating eating disorders using CBT.
- Exposure to triggering events or situations, facilitated by the therapist. This helps the individual to face foods or situations that increase their anxiety and involves the therapist’s intervention to create healthier coping mechanisms.
Dialectical Behavior Therapy (DBT) is based on CBT, but incorporates more mindfulness practices and other emotional coping techniques. Its core strength is in helping people who experience intense emotions to restrict impulsive behaviors. An example of this could be if someone has a strong emotional reaction that results in an impulsive disordered eating behavior, such as binging or purging. DBT would aim to cope with these strong emotional reactions in ways that are less impulsive and promote behaviors that are healthier and kinder to the person. DBT includes skill building to:
- Create and maintain mindfulness practices
- Develop better interpersonal relationships and communication skills
- Manage and understand your emotions (emotional regulation skills)
- Cope with stressors
The role of trauma in triggering ED behaviors and negative thoughts is an important factor to consider in treating eating disorders. Whether ACT, CBT, or DBT or any other treatment modalities are utilized, a core consideration is that the therapist is trained to understand the complex relationship between trauma and EDs. Holistic care considers all parts of the person’s life and understands that they don’t live in a bubble. Trauma-informed care creates a safe and supportive space for the resident to unpack their experiences and facilitates healthy recovery.
Eating disorders, much like many mental health conditions, affect both the individual and those closest to them. At Koru Spring, working with family and support systems is an important component of recovery. Residents engage in family therapy group sessions and relearn how to communicate and hold space in group therapy sessions.
Family and friends of those with an eating disorder can provide support in many ways, some of which may seem small, but all of which are important. One way to provide support is by learning more about eating disorders and gaining insight into the psychological and physiological aspects of these mental illnesses. More practical support mechanisms may include meal support, perhaps by helping the individual in meal planning and preparation, or helping the individual find treatment.
Family members and family dynamics can also play an important role in how eating disorders develop and are maintained, either directly or indirectly. Group therapy or family therapy can facilitate healing on this front. By seeking their own individual therapy and support, family members and friends can ensure that they have the skills and capacity to support their loved ones in a way that is healthy and sustainable.
Another consideration in the psychological treatment of eating disorders is whether group or individual therapy would suit the individual seeking treatment better. The answer is that both play an important role in recovery. Some of the benefits of individual vs. group therapy overlap, such as introspection, gaining emotional insight, and learning tools to help in recovery. However, they also have their unique strengths, some of which may appeal more to the person in treatment than others. These benefits can include:
Benefits of Individual Therapy
- Personalized treatment that is focused entirely on the individual. Working one-on-one with a therapist can build a strong and supportive relationship and create a safe space to explore difficult thoughts, feelings and experiences. This is tailored and curated to facilitate the individual’s recovery process.
- Confidentiality is inherent in this type of therapy, as only the person and their therapist are present.
- More flexible scheduling options. Outpatient sessions can be scheduled at times that suit the individual and are negotiated between the client and therapist. There is also more flexibility around the content covered in the session. Group sessions usually follow topics or exercises determined by the facilitating therapists and follow a flow that is highly influenced by group members. In individual sessions the person and the therapist have more control over these factors.
- Support from a great relationship with a therapist that really “gets you” is a great safety net that the individual can fall back on in times of difficulty and use as a safe and supportive space to start their recovery journey. The therapist doesn’t change between sessions, so the individual can go into great depth and discover recurring patterns.
Benefits of Group Therapy
- A sense of connection and not being alone in their struggles with an eating disorder is one of the greatest benefits of group therapy. Many people with eating disorders find themselves feeling isolated and group therapy encourages participation from everyone.
- Shared experiences and a sense of community can be powerful in supporting and facilitating recovery from an eating disorder and is a benefit of group therapy.
- Feedback and shared learning from other group members and the facilitator helps to normalize the recovery process and can create deep moments of insight and connection between two people with the same struggles who may never have met otherwise.
- The cost-effective nature of group therapy (many outpatient support groups for eating disorders are free) makes it more accessible for some individuals.
For women, many of the risk factors and triggers leading to the development and maintenance of an eating disorder can relate to societal ideals of body shape and image. All-women groups can help address these negative thoughts and emotions, by creating safe spaces where trust is built, experiences are shared and many of these preconceptions are challenged. For women who may have had traumatic experiences with men in the past, this is also a place to find a sense of security and belonging.
Psychological treatments may involve individual, group, family, and experiential therapy. No one type of treatment is necessarily “better”, rather they serve different purposes in a holistic treatment plan. Each person will have a combination of these that works best to progress their recovery journey. Different people may find that some approaches work better for them than others, making each person’s psychological treatment plan unique.
It can seem overwhelming to face all of these treatment options. Which is best, how do you start? A benefit of seeking inpatient treatment at a residential treatment center, such as Koru Spring, is that experts in the field have already developed an evidence-based treatment program that individuals can experience in a safe and supportive environment. The program also includes nutritional support, experiential therapies and recreational activities that contribute to a well-rounded and holistic recovery journey.
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