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Objectives (2 minutes)
I. Exposure Therapy with a nutrition focus (15 minutes)
A. Origins in OCD and PTSD
B. Deprivation-Binge cycle in BN
C. Anxiety and food avoidance in AN
II. Exposure (15 minutes)
A. Smell
B. Appearance
C. Location
D. Sitting before the food
E. Trying the food with the RD and Therapist present in the location
F. Processing the experience
III. Desensitize: (15 minutes)
A. Examples with AN
B. Examples in BN to break the deprivation/binge cycle
IV. Normalize behaviors (10 minutes)
A. Examples of normalized behaviors with eating a variety of previously feared foods
B. The expansion of the “safe food box”
V. Video examples (20 minutes)
1. Cooking challenges/baking
2. McDonalds challenge
3. Family style dinners
4. Grocery shopping
5. Binge food challenges
VI. Conclusion/ Q &A (10 minutes)
A. Summarize information
B. Restate objectives
Society is dominated by triggering messages for a very sensitive eating disordered population. Residential and hospital-based treatment act as a safe haven cocoon for residents to avoid the triggers for a time. Unfortunately, they are thrown back into the harsh realities and often they do not feel prepared. The focus of this presentation will be to teach the attendees unique methods for which to better prepare their clients for real world challenges.
Eating disorders often times occur concurrently with anxiety or obsessive traits. This compulsion tends manifest with food. Anorexic clients often become phobic of certain macronutrients like fats or carbohydrates. Bulimic clients tend to restrict themselves from foods they perceive as “bad.” This is the start of the deprivation/binge/purge cycle of eating. Common wisdom has directed the dietitian to experiment with teaching the clients to give themselves permission to consume “bad” foods in moderation, thereby reducing their anxiety toward them. In a sense, what the dietitian is doing is a form of Exposure Therapy. Exposure Therapy is a method where the client is exposed to the stimulus, desensitized, and the behaviors are normalized (Steinglass, et. al., 2007).
This workshop will focus on using Exposure Therapy for all types of eating disorders. The facilitator will show videotaped examples of clients performing some of the tasks necessary to desensitize them to the stimulus. Attendees will see and learn how to do activities with cooking, restaurant, fast food, and binge food challenges. Attendees will take away concrete examples of how to repeat these unique challenges in their own practices.
Rachel Liger is a registered dietician and has served as the Director of Nutrition Services at Center for Discovery for over the past eight years. At the Center, Rachel is credited with the development of the nutrition program that now extends to Discovery's four residential facilities. Rachel utilizes innovative approaches and paradoxical methods for nutrition education and re-feeding of malnourished individuals. Additionally, she lectures extensively in the community and serves as an adjunct professor at California State University Long Beach. Rachel has developed a dietary mentoring program that has served to educate students and RD interns about the sensitive nature of the dietary management of eating disorders. She received her masters from California State University Long Beach and while there designed and implemented an original clinical trial study on the effectiveness of the dietician for weight loss management when medications are used.
