Two weeks ago I attended the International Conference on Eating Disorders, a conference sponsored by the Academy for Eating Disorders. My attendance at the annual conference allow me to stay up to date on the most recent advances in treatment and provide the best and most recent treatments in my practice. My involvement in the Academy allows me to connect with clinicians and researchers from all over the world and participate in AED committees and special interest groups. I also keep up to date through the International Journal of Eating Disorders, the AED listserve, and AED’s social media sites.
Highlights from the International Conference on Eating Disorders 2012
- Meeting and spending time with some of the major family and patient advocates, other FBT providers, and clinicians and researchers from around the world all coming together to improve treatment for patients suffering from eating disorders.
- The opportunity to meet and learn from some of the leading researchers in the area of eating disorders.
- Learning about the most recent and ongoing studies.
A synopsis of one of my favorite talks below:
Tidbits from Tim Walsh and his group at Columbia: A New Model for Understanding Anorexia Nervosa and Implications for Treatment
In anorexia, dieting begets weight loss which begets more dieting… why is dieting such a persistent behavior? Tim Walsh and his group believe that operant conditioning, which is implicated in habit formation, offers an explanation.
In operant conditioning, an action is reinforced and this increases the likelihood that the individual will perform the action again. Repeatedly reinforced behavior becomes almost automatic. Stress also promotes habit formation. And random intermittent reinforcement patterns make behavior even more difficult to extinguish.
According to Walsh, a major reason for the persistence of Anorexia Nervosa is that dieting begins as goal-directed, but becomes habitual. Dieting is learned, it requires repetition, and becomes almost unconscious over time. It involves structured behavior. Initially it is rewarding. Rewards – such as weight loss and compliments – often become intermittent. Dieting occurs during times of multiple stresses (adolescence). It is particularly effective at enhancing self-esteem in girls. It also becomes a way to deal with negative affect and anxiety which provides additional (negative) reinforcement.
Walsh’s group tested treatments based on this theory. Exposure (to foods) and response prevention resulted in weight gain and decreased anxiety. The best predictors of positive outcome: higher percentage of fat in diet, higher energy density of food, and better variety in diet. Exposure and response prevention, which confronts eating related fears, provided very successful outcomes.
Both Cognitive Behavioral Therapy and Family Based Therapy (two treatments I provide) utilize exposure. To read more about exposure, read my post on Exposure in the Treatment of Eating Disorders.