Friday, February 8, 2019: 8:30 AM-10:00 AM
Desert Salon 5/6 (JW Marriott Desert Springs Resort and Spa)
Background:
Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and Eating Disorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating or food. ARFID is so new that there is no evidence-based treatment. This workshop will fill an important gap for colleagues who are already seeing such patients in clinical practice by providing specialized training in a new form of cognitive-behavioral therapy for ARFID (CBT-AR) that we have recently developed and tested at Massachusetts General Hospital.
Objectives:
After this workshop, attendees will be able to:
- Describe the basic structure, goals, and session format of CBT-AR for children, adolescents, and adults with ARFID.
- Implement the four basic stages of CBT-AR including (1) psychoeducation and early change; (2) treatment planning; (3) addressing maintaining mechanisms in each ARFID domain; and (4) relapse prevention.
- Tailor CBT-AR to a patient’s unique ARFID presentation by implementing optional modules (e.g., food exposure for sensory sensitivity, interoceptive exposure for low appetite, fear/avoidance hierarchy for fear of aversive consequences) as needed.
Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and EatingDisorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or apparent lack of interest in eating or food. ARFID is so new that there is currently no evidence-based treatment for the disorder. My colleagues and I have developed and manualized a novel treatment—Cognitive-Behavioral Therapy for ARFID (CBT-AR)—that we are testing in a foundation-funded treatment study at Massachusetts General Hospital in Boston. CBT-AR can be offered in an individual or family-supported format and comprises four stages: (1) psychoeducation and early change; (2) treatment planning; (3) addressing maintaining mechanisms (including sensorysensitivity, fear of aversive consequences, and/or lack of interest in eating or food); and (4) relapse prevention over 20-30 sessions. We have published a case report describing the successful treatment of an 11-year-old girl with CBT-AR in the New England Journal of Medicine, and we have enrolled 20 CBT-AR trial participants from our ongoing National Institute of Mental Health fundedgrant on children and young adults with ARFID entitled “Neurobiological and Behavioral RiskMechanisms of Youth Avoidant/Restrictive Eating Trajectories” (R01MH108595). Initial results from the first 13 completers are promising, with patients incorporating an average of 17 new foods (SD = 5.0) and underweight patients gaining an average of 11.8 lbs (SD = 7.5 lbs) by the end of treatment. This interactive workshop will begin with a brief didactic description of the rationale for and goals of CBT-AR and detailed case examples drawnfrom a heterogeneous group of children and adults who have benefitted from this treatment (35 mins). We will then use role-plays, session audiotapes, and experiential exercises (e.g., in-session food exposure for sensory sensitivity, interoceptive exposure for low appetite) to demonstrate CBT-AR techniques across the four stages of this flexible, modular treatment (40 mins). We will leave ample time for questions and discussion at the workshop’s conclusion (15 mins).
Avoidant/Restrictive Food Intake Disorder (ARFID) was recently added to the Feeding and Eating Disorders section of DSM-5 to describe children, adolescents, and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of aversive consequences, and/or lack of interest in eating or food. ARFID is so new that there is no evidence-based treatment. This workshop will fill an important gap for colleagues who are already seeing such patients in clinical practice by providing specialized training in a new form of cognitive-behavioral therapy for ARFID (CBT-AR) that we have recently developed and tested at Massachusetts General Hospital. We have preliminary efficacy data on the treatment from our initial pilot study of 20 patients ages 10-22 years old. In the workshop we will present the basic tenets and four broad stages of CBT-AR, along with experiential exercises to demonstrate specific interventions. We will present case examples, including session audiotapes from our ongoing clinical trial. Lastly, we will welcome questions from the audience throughout the presentation as well as a discussion at the conclusion of the workshop.
Primary Presenter:
Jennifer Thomas, PhD
Dr. Jennifer Thomas is the Co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital, and an Associate Professor of Psychiatry at Harvard Medical School. Dr. Thomas’s research focuses on atypical eating disorders, as described in her books Almost Anorexic: Is My (or My Loved One’s) Relationship with Food a Problem? and Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. She is currently principal investigator on several studies investigating the neurobiology and treatment of avoidant/restrictive food intake disorder, funded by the U.S. National Institute of Mental Health and private foundations. She is the author or co-author of over 100 scientific publications. She is also the Director of Annual Meetings for the Academy for Eating Disorders and an Associate Editor for the International Journal of Eating Disorders.
Co-Presenter:
Kamryn Eddy, PhD
Dr. Eddy is the Co-Director of the Eating Disorders Clinical and Research Program (EDCRP) at Massachusetts General Hospital and an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. She is the co-creator of Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR). Dr. Eddy focuses her research on the diagnostic classification of eating disorders, particularly among children and adolescents. She is the author or co-author of more than 120 scientific publications, and co-author of the book Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, and Adults. She is currently Principal Investigator on an NIMH-funded study of the neurobiology underlying illness course and recovery in adolescents, and leads one of the longest-running outcome studies of anorexia nervosa and bulimia nervosa examining recovery rates over 25 years.
