There’s a significant treatment gap when it comes to adults with eating disorders: Nearly 30 million Americans will develop an eating disorder in their lifetime, but only about 20% will get treatment.
It’s possible that many aren’t familiar with the treatment options. While Family-Based Treatment is the gold standard treatment for children and adolescents this method isn’t feasible or appealing for many adults.
So what are the treatments that are proven to successfully help adult patients? Here are four evidence-based modalities that are proven to work, and have varying levels of success depending on the individual, that we frequently use here at Equip.
Enhanced cognitive behavioral treatment (CBT-E)
Enhanced cognitive behavioral treatment, otherwise known as CBT-E, is one of the most effective eating disorder treatments for adults. It was developed for outpatient eating disorder patients, but can also be used in other settings. According to Shannon Patterson, M.Ed., Ph.D., and clinical instructor at Equip, “CBT-E encourages patients to become curious about their eating habits. Through the use of strategic behavior changes, such as regular eating routines and new coping skills, patients are able to see changes in their thought patterns and symptoms.”
CBT-E is a highly collaborative 1:1 individual psychotherapy that encourages patients to become curious about their eating problems and the expert on their lived experience. Through the use of strategic behavior changes between sessions, such as regular eating and use of new coping strategies, patients are often able to see changes in their thought patterns and symptoms.
CBT-E treatment typically lasts 20-40 weeks and is broken up into four stages: changing patterns, evaluating next steps, challenging the root of the disorder, and preparing for life after treatment. The goal of CBT-E is to “reduce disordered eating by changing behavior patterns and challenging less helpful beliefs that affect the patient’s self-worth,” says Patterson. CBT-E also explores the influence that personal relationships, cultural environment, societal stigma, and discrimination or trauma may have on the eating disorder.
What CBT-E looks like in action
CBT-E has the greatest breadth of research proving its effectiveness in treating adults. One 2020 study found that patients in CBT-E treatment were more likely to recover from an eating disorder within 20 weeks and also showed significant improvements with self-esteem. CBT-E has various rates of remission depending on diagnosis, with a recent meta-analysis finding that it is most effective in treating bulimia and binge eating disorder in adults.
Cognitive Behavior Therapy for Avoidant Restrictive Food Intake Disorder (CBT-AR)
CBT-AR is an offshoot of CBT that is specifically designed to treat Avoidant Restrictive Food Intake Disorder (ARFID). “During CBT-AR, the patient and their therapist work together to reestablish nourishment. Then, the heart of the treatment helps them gain experience with new or feared foods, and with facing situations that make it hard to eat,” says Director of Adult Programs at Equip Lara Effland, LICSW.
Effland explains, “CBT-AR can help a patient obtain weight restoration, correct nutritional deficiencies, eat foods from all five basic food groups, and feel more comfortable in social situations.” This is a gradual process over an average of 20-30 weekly sessions.
There’s still research needed when it comes to quantifying CBT-AR effectiveness for treating ARFID, however there’s been an increase in evidence to suggest that it can be helpful.
One study found that nearly 50% of CBT-AR patients no longer met criteria for ARFID by the end of their treatment. An even greater number, 80% were rated as “much improved” by their therapists. CBT-AR patients were also able to incorporate an average of 18 new foods, and those in need of weight restoration gained an average of over 11 pounds.
“We suspect that CBT-AR is effective because it helps people face and overcome their eating-related fears. Patients gradually discover that it is possible for them to get through difficult situations and start feeling more comfortable around fear foods,” says Patterson.
Family-Based Treatment for Transition Aged Youth (FBT-TAY)
FBT-TAY is a form of family-based treatment for young adults aged 18-26 who may be living at home. Having family play a more hands-on role can be particularly beneficial for patients while in this transitory phase of life, whether they’re balancing treatment with college or building independence in their early professional life. They can help provide the meal prep, supportive environment, and accountability that the patient might not have on their own.
“In FBT-TAY, therapy is similar to traditional FBT in that it’s based on the idea that family members or positive supporters are the ones best suited to help their loved ones recover. It empowers patients’ families to be active participants in their recovery,” says Patterson.
How FBT-TAY compares to FBT
One of the main differences between FBT-TAY and FBT is that there’s a greater amount of independence for a FBT-TAY patient. “In Equip treatment, we encourage young adults to be an active collaborator in their treatment” says Patterson. She adds that the type of supporters may also be different: “Many young adults may have valuable supporters who aren’t family members, like friends or romantic partners, who we welcome into their treatment.”
The three stages of FBT-TAY are similar to FBT: in the initial period the family prepares meals, the patient gradually returns to managing their own meals, and then ultimately establishes full autonomy. However, there’s a greater level of independence established for FBT-TAY patients throughout all three stages. One study of anorexia patients found that FBT-TAY led to significant improvement in symptoms and weight restoration both by the end of treatment and three months after.
Dialectical Behavior Therapy (DBT)
The basic philosophy of DBT is to “provide tools that help people accept hard realities in their life and change unhelpful thoughts and behaviors,” says Patterson. DBT focuses on four key skills: mindfulness, distress tolerance, emotion regulation, and relationship strengthening.
How DBT is applied in eating disorder treatment
DBT can help eating disorder patients cope with distress around meal times, regulate emotions that may trigger disordered behaviors, and specifically interrupt the binge-restrict cycle. DBT may also improve a patient’s communication skills with their support system, treatment team, and other people in their life.
Some examples of DBT skills used in eating disorder treatment are:
- DEAR MAN Technique: Which stands for “Describe, express, assert, reinforce, mindfulness, appear confident, and negotiate” and is a skill for asking for what you need.
- Opposite Action: Which is a technique that encourages individuals to act in a way that is opposite to their emotional instinct.
- Observing and Describing: This DBT skill asks individuals to observe and put into words their thoughts, emotions, and physical sensations without judgment.
Initial studies show that DBT appears effective in addressing both eating disorder behaviors and co-occurring diagnoses. Another study of women with binge eating disorder found that patients who received DBT had greater reductions in symptoms such as bingeing, eating issues, body image, and anger.
Additional treatment modalities for treating eating disorder in adults
There are several other therapy techniques that are used with adult patients and combined with other modalities. Some additional treatments include:
Exposure-Based Therapy (EBT)
In this therapy the patient is gradually exposed or reintroduced to the things they’ve developed chronic fear or anxiety around. In eating disorder treatment, this means facing the fears and triggers that contribute to disordered eating behaviors. This could include fear of certain foods, eating in public, or exercise.
Motivational Interviewing (MI)
MI is a collaborative form of therapy in which the therapist guides a patient to explore their feelings of ambivalence or insecurity that might be blocking their motivation to change. One study found that patients who took part in MI were 38% more likely to complete eating disorder treatment.
Treatment at Equip
Equip provides virtual, evidence-based eating disorder treatment, so patients can recover at home. Our clinicians are highly trained in each treatment listed above, and utilize therapy modalities depending on the individual. For example, an older adult with ARFID may be treated with CBT-AR, whereas a younger adult with the same diagnosis may respond best to FBT-TAY. If communication and relationship difficulties are main triggers for an adult with bulimia, they may respond well to CBT-E and involvement in a DBT skills group.
These treatments are delivered by a multidisciplinary care team of a therapist, medical provider, dietician, and peer mentor who has experience recovering from an eating disorder. Equip also invites the patient to be an active collaborator in their treatment. Together, the team and patient partner to ensure the best method is being used, and make changes when necessary.
Lasting recovery is possible and there are many science-backed treatments to help you get there. Schedule a free consultation to learn more about treatment at Equip.
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