Background: It is not uncommon for individuals with eating disorders to have strong, aversive reactions to situations that occur in everyday life. If we understand eating disorders as emotional disorders, then we should consider interventions that have demonstrated efficacy with other disorders having similar underlying mechanisms, such as anxiety and panic disorders. These interventions that approach emotion, rather than avoid emotion, increase emotional tolerance and decrease the drive to use eating disorder behaviors. This workshop will explore the rationale and application of novel, and somewhat controversial, evidence-based interventions such as open weighing, interoceptive exposure, body image/mirror exposure, and social exposure.
Objectives: 1) Attendees will be able to list the evidence-based principles of emotional exposure that apply to each of the demonstrated interventions (e.g., open weighing, interoceptive exposure, body image exposure, social exposure).
2) Attendees will be able to describe two benefits of open weighing versus blind weighing and explain how to address client resistance to or apprehension about this intervention.
3) Attendees will be able to explain the rationale for increasing tolerance of uncomfortable physical sensations often associated with eating disorders such as hunger, fullness, digestion, nausea, and mechanoreception (feeling of clothing on body).
- Eating Disorders as Emotional Disorders
- Exploration of shared, underlying core mechanisms of eating disorders and other emotional disorders (i.e., anxiety, mood, somatic, trauma, substance use disorders)
- Exploration of maintaining factors of eating disorders
- Function of eating disorder symptomatology as emotional and experiential avoidance
- The role of negative reinforcement
- Evidence-based principles of emotional exposure
- Mindfulness as a necessary pre-condition to exposure
- Proper structure
- Exploration of expectancies before and after
- SUDS & emotion tracking
- Desirable level of difficulty. Where to start? When are you “done”?
- The case against flooding or moving too fast
- Expected safety behaviors & why “now is not the time”
- Variability, repetition and the grand prize: generalizability!
- Clinician behaviors: managing your own anticipatory anxiety
- Combining exposure types for optimal tolerance building
- Video: Exposure Therapy demos
- Novel (and controversial) exposure with eating disorders: Open Weighing
- Brief review of literature support
- Preparing the patient & responding empathically and appropriately to resistance, apprehension and fear
- Contraindications
- How to carry out: step by step
- Experiential: role play with audience participants
- Novel (and controversial) exposure with eating disorders: Interoceptive Exposure (IE)
- Brief review of literature support & transdiagnostic uses of IE
- Important considerations & potential contraindications.
- Preparing the patient & responding empathically and appropriately to resistance, apprehension and fear
- How to carry out: step by step
- Experiential: demonstration and practice with audience
- Novel (and controversial) exposure with eating disorders: Body Image/Mirror Exposure
- Brief review of literature support
- Important considerations & potential contraindications.
- Preparing the patient & responding empathically and appropriately to resistance, apprehension and fear
- How to carry out: step by step
- Experiential: demonstration
- Novel exposure with eating disorders: Social Exposure
- Making the case for inclusion of social exposure in ED patient exposure hierarchy (even if they are not diagnosed with Social Anxiety Disorder)
- Video: in vivo social exposure
- Detailed Case example: complex ED patient in which each of the exposure interventions were utilized (separately and in combination) to attend to her unique presentation and concerns.
If we understand eating disorders as emotional disorders, then it makes sense to consider evidence-based interventions that have demonstrated efficacy with other disorders with similar underlying mechanisms, such as anxiety and panic disorders. Because recovery requires experiential challenge, interventions that approach, rather than avoid, emotion can increase emotional tolerance and decrease the drive to use eating disorder behaviors.
In this workshop, participants will explore the rationale and application of novel, and somewhat controversial, evidence-based interventions such as open weighing (Waller, 2014), interoceptive exposure, body image/mirror exposure (Hildebrandt et al., 2012), and social exposure. While each of these interventions has evidentiary support for their use in the treatment of eating disorders, they remain controversial in the field at large due to their evocative nature and clinician concerns regarding the consequences of stimulating negative affect. This presentation aims to support the notion that not only is the stimulation of negative affect safe and permissible, but is imperative for creating sustainable change in individuals with eating disorders and comorbid conditions.
Melanie Smith, M.S., LMHC is the Director of Training for The Renfrew Center. In this role she is responsible for developing and implementing clinical training and programming that is consistent with emerging research and evidence-based practice. Ms. Smith provides ongoing supervision and consultation to Renfrew staff to assess and improve fidelity and competence of treatment delivery of The Renfrew Unified Treatment Model for Eating Disorders™. She has extensive training and experience in the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) and is a UP Certified Therapist and Trainer.
Tracey Kurland, MS, RD, is a Registered Dietitian at The Renfrew Center of Los Angeles. Tracey has treated eating disorder patients in inpatient, day treatment, intensive outpatient, and private practice settings. She is passionate about facilitating her clients ability to create both a positive relationship with food and live a fulfilled life. Tracey earned her Master of Science Degree in Nutrition Education from Columbia University, and her Bachelor of Science Degree in Communication and Business from the University of Southern California.
