Empirically Validated Treatments

Empirically Validated Treatments For Eating Disorders Today’s Los Angeles Times contained an article which highlights Family Based Treatment and Cognitive Behavioral Treatment, two treatments I provide: Today, doctors and therapists focus on a handful of treatments that have been validated by clinical studies. For teens with anorexia, the first-line treatment is something called family-based therapy, …

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Traveling With Your Anorexic

Traveling With Your Anorexic

Traveling With Your Anorexic [image description: photo of person looking out at Machu Picchu]By Lauren Muhlheim, Psy.D. and Therese Waterhous, Ph.D.

Families often ask whether they should proceed with a previously scheduled trip or take a well-deserved “break” during the refeeding process.  We advise that travel during Phase 1 of FBT be avoided if at all possible.  We know several families who have vacationed with a child well along in treatment for anorexia and found their child lost 5 to 10 pounds over the course of a week, erasing months of progress.  Children and young adults with anorexia have difficulty with change; if a child is having difficulty completing meals in the home, it is unlikely that they will be able to do so on vacation, where most meals will be eaten in an unfamiliar setting in the presence of non-family members.

During vacation, parents may be tempted to give in more easily to the anorexic thinking and behaviors because they do not want to upset other diners in a restaurant or because they “don’t want to ruin” the vacation after they’ve invested a lot of money in getting there.  The food may be different than that available at home, or it may be difficult to get the types of foods on which the family has been relying.  Children and young adults with anorexia are inflexible; if the food is different than that to which they are accustomed, they may refuse to eat at all.  Sightseeing often involves a lot of walking, which can burn a lot more calories and require even greater caloric intake to offset.  Many vacations occur in warm climates, where health problems related to malnourishment or dehydration may be magnified.  If families do travel during Phase 1 or Phase 2, they should be cautioned that it may cause a setback and prolong the recovery process.

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Exposure in the treatment of Eating Disorders

Exposure therapy is widely recognized as a necessary (and sometimes sufficient) ingredient of treatment for most of the anxiety disorders including phobias, panic disorder, and obsessive compulsive disorder.  Anxiety is a core psychological feature of anorexia nervosa and bulimia nervosa.  However, instead of being afraid of heights, speaking in public, having a heart attack, or contamination, individuals with eating disorders are primarily afraid of food, eating, and shape and weight.

Both cognitive-behavioral therapy and family based treatment, two empirically validated treatments for eating disorders, employ exposure techniques.  Exposure works through the process of habituation, the natural neurologically-based tendency to get used to things to which you are exposed for a long time.   During exposure, habituation occurs as people acclimate to their fear and come to realize that nothing actually dangerous is occurring. Habituation promotes new learning of safety, tolerance of fear feelings, and extinction of the fear avoidance urge. 

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Surviving the first week of re-feeding

Family-Based-Treatment [image description: sugar cookies frosted with the words "Feed," "Love," and "Heal"]Surviving the first week of re-feeding your child using (Maudsley) Family-Based Treatment

In Family-Based Treatment (FBT), figuring out how to get your starving child to eat and gain weight is a daunting task. Parents often feel overwhelmed and helpless when starting out on a re-feeding program. It is important to remember that your child is literally more afraid of the food than of dying of starvation. But food is the medicine, and it is your job to save her (or his) life.

Anorexia makes children do things they would never normally do and an escalation of behavior is common when parents start to stand up to the anorexia. In fact, an escalation during the first week, although unpleasant and often scary, is usually a good sign that parents are not giving in to the anorexia. Consistent confrontation of the anorexia ultimately brings greater compliance as well as weight gain. It is imperative that parents work together and are well aligned; otherwise the anorexia can split them and gain strength.

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Mindful Eating

The definition of binge eating is “the consumption of large amounts of food associated with a feeling of loss of control over eating.”  Individuals who binge eat describe the experience as almost dissociative.  They are frantically eating large amounts of food which they are barely tasting.  They feel unable to stop until they are uncomfortably full.

One skill that I teach clients who binge eat and overeat is mindful eating.  Mindfulness is a Buddhist principle that involves being fully aware of what is going on both inside yourself and in your environment at the moment.  Mindfulness is a skill that anyone can develop.

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Free fitness Hollywood/miracle mile area

I commonly see patients in my psychology practice for depression, anxiety, and other emotional complaints. When I’m taking someone’s history, there’s one question I always ask which may surprise you:
“Tell me how often you exercise.”

The benefits of exercise are enormous and well documented: exercise invigorates, improves mood, reduces anxiety and stress, boosts self-esteem, and improves focus and concentration.

Many of my clients who are new to Los Angeles struggle to develop an exercise regimen here. Many feel overwhelmed and don’t feel they have the time. If this is the issue, change your perspective: exercise isn’t adding to your problem – it’s part of the solution. Exercise is one of the simplest, least expensive ways to manage stress and maintain life balance. With a little creativity, you can build exercise into your routine here.

Sometimes cost is an issue. If running in the great LA weather doesn’t appeal and joining a gym in the Hollywood area is too expensive, there are still numerous opportunities for free and FUN fitness in the area. All of these offer the opportunity to meet people as well.

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Family-based treatment for adolescent eating disorders

Eating disorders, including Anorexia Nervosa and Bulimia Nervosa, are affecting greater numbers of adolescents and even children and early intervention is critical. If not identified or treated early, eating disorders can become chronic and cause serious or even life-threatening medical problems. Anorexia Nervosa is the most dangerous, with the highest death rate, of any mental …

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