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Acceptance & Commitment Therapy In The Treatment of Eating Disorders

Acceptance & Commitment Therapy In The Treatment of Eating Disorders . Emmett Bishop, MD Eating Recovery Center, Denver, Colorado Jennifer Lombardi, MFT Eating Recovery Center of California, Sacramento, California. Why ACT?. Eating Disorders Highest mortality rate of any mental illness

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Acceptance & Commitment Therapy In The Treatment of Eating Disorders

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  1. Acceptance & Commitment Therapy In The Treatment of Eating Disorders Emmett Bishop, MDEating Recovery Center, Denver, Colorado Jennifer Lombardi, MFTEating Recovery Center of California, Sacramento, California

  2. Why ACT? • Eating Disorders • Highest mortality rate of any mental illness • High non-response and relapse rates • Prevalence of co-morbid anxiety & depression • Temperament

  3. Eating Disorder Treatment • Inpatient • Residential • Partial Hospitalization/Day Treatment • Intensive Outpatient • Outpatient

  4. How ED “Manages” • Anorexia • Biology • Serotonergic system overactive – restricting decreases anxiety • Imbalance in dopamine/serotonin systems • Aversive response to DA release with food • Temperament • Harm avoidance • Novelty seeking • Reward dependence • Self-directedness • Social • Experiential avoidance • Withdrawal and/or hyper-vigilance related to performance

  5. Temperament and Character Inventory

  6. How ED “Manages” • Bulimia • Biology • Endogenous opiate release with purging • Reward circuitry • Temperament • Harm Avoidance • Novelty seeking • Self-directedness • Social • Experiential avoidance • Emotion-regulation

  7. Treatment Modalities • Family-based therapy • CBT • DBT • Initial medical focus • Followed by behavioral

  8. Why ACT • Contextual framework • “… families may benefit from using both practical strategies such a feeding support and also theoretical strategies such as psycho- education about the illness.” • Reframes the illness in a non-shaming way (LoTempio, et al, 2013)

  9. Why ACT • Willingness • Considers what patients say that do not want from therapist/treatment* • Lack of validation for the ED • Inflexible use of theory • View of patient as ED vs. an individual • ACT encourages exploration of ED purpose and alternatives to manage (Gulliksen, et al, 2012; Juarascio et al., 2013)

  10. Why ACT • Values • Explore life beyond ED • What do ED patients state that they want from treatment? • Motivational “hooks”* • Firm empathy • ED is one choice of managing • Weave motivational/values work into treatment • Committed action connected to values (Glenn Waller, 2012)

  11. Current Research • TCI • AAQ-W • BI-AAQ • CAQ

  12. AAQ-WN=521

  13. BI-AAQN=465

  14. Eating Disorder Index CorrelationsN=833 Correlations >0.5 are included

  15. Temperament and Character Inventory Correlations N=857 Correlations >0.3 are included

  16. Case Study • Female patient • Age 35 at onset of IOP tx • Multiple treatment episodes beginning age 26 • Inpatient psych, residential, PHP, IOP, OP • History of AN & BN beginning at age 14 • Co-morbid PTSD, major depressive disorder • Trauma • Sexual abuse beginning at age 5 • College graduate • Social isolation

  17. Case Study • Treatment modalities • CBT • DBT • Family systems work • Art therapy • Psychodynamic • Results: • Repeated episodes of gaining weight, social improvement while in treatment • Relapse, on average, within 6 months

  18. Case Study • Shift in focus of treatment • Willingness • Specifically around trauma & involvement of support system • Acceptance • Limitations of family system, loss of stepfather • Values • Social connection, career/meaning of work

  19. Case Study • Biology • Decreased medications • Depressive sx decreased • Temperament • Increased assertiveness • Ability to engage in self-care • Imperfection in work • Social • Roommate • Social activities

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