Research shows that the best treatment for most adults with anorexia is CBT-E (enhanced cognitive behavioral therapy),1, 2 provided in the least restrictive setting possible (in other words, in an office setting rather than a hospital setting)3. Unless there are medical complications that warrant hospitalization, treating anorexia within the context of real life is optimal.
The Evidence Base for Anorexia
At Columbus Park, CBT-E is our go-to for our adult anorexia nervosa (AN) patients. CBT-E creates a structure to help our clients manage decisions about what to eat, how much to eat, and how often to eat—all in the context of their day-to-day, moment-by-moment life. The first stage of treatment is entirely dedicated to creating a regular, stable pattern of eating. We provide strategies for tracking eating (without getting too obsessive), planning ahead and coping with the feelings that come up around nourishing oneself.
Creative Solutions to the Anorexia Challenge
Recovery from anorexia requires nutritional rehabilitation and weight restoration—not an easy feat when eating food and gaining weight are the most frightening concepts imaginable to someone with anorexia. Even with the best intentions around recovery, every adequate meal and snack can feel like you’re stepping off a cliff.
For this reason, we are flexible and creative in our approach to each AN client during the re-feeding and recovery process.
- Friends and Family: Enlisting support from loved ones when dealing with an illness like AN is essential. We encourage family involvement whenever possible – even for our adult patients. We help “inner circle” members (parents, spouses, close friends) learn how to be effective allies in the fight against the disorder.
- Supported meals: Either one-on-one or in the group setting at our Center, we provide lunch and dinner meals structured to give our AN patients the support needed to meet nutrition needs. Our clients frequently report feeling relieved to have a reliable and stable structure of supported meals in place.
- Smart Phone Apps: We use smart phone applications that help our clients log intake and track their food-related thoughts and behaviors throughout the day. Therapists are able to view patient activity in the app in real time between sessions and can reach out through the app to offer encouragement or guidance.
- Video Therapy Sessions: Our therapists can “be present” via video to support the completion of snacks, meals and/or supplements without the client even having to come into the office. In light of how many meals and snacks we require in a given day, this extra support – with no travel time necessary! – can be invaluable.
- Phone coaching: In some cases, we set up phone check-ins between in-person sessions. If a client is struggling to meet his/her needs, we can arrange focused contact structured to coach clients through the obstacles to eating adequately.
1Hay P, Chinn D, Forbes D, Madden S, Newton R, Sugenor L, Touyz S, Ward W. Australian & New Zealand Journal of Psychiatry 2014, Vol. 48(11) 977–1008
2Fairburn, C. G., Cooper, Z., Doll, H. A., O’Connor, M. E., Palmer, R. L., & Dalle Grave, R. (2013). Enhanced cognitive behaviour therapy for adults with anorexia nervosa: a UK-Italy study. Behaviour Research and Therapy, 51, R2eR8
3Madden S, Hay P, Touyz S. Systematic review of evidence for different treatment settings in anorexia nervosa. World Journal of Psychiatry. 2015; 5(1):147-153. doi:10.5498/wjp.v5.i1.147.