Evidence Based Eating Disorder Treatment
At Valenta, we emphasize the use of evidenced-based Eating Disorder treatment. The core of our program utilizes therapy modalities proven to be an effective Eating Disorder treatment as well as other comorbid psychiatric disorders. (Note: comorbidity means the presence of one or more disorders [or diseases] in addition to a primary disease or disorder.) Some of these therapy techniques are cognitive-behavioral therapy (CBT), art therapy, and dialectical behavioral therapy (DBT).
In addition, given the complexity and comorbidity of Eating Disorder treatment, we are also extremely innovative and constantly work to bring in emerging treatment modalities from around the world, such as *MBT, to help patients recover. We are actively involved in research used to determine efficacy in our multimodal treatment and improvement of treatment and outcomes for our patients.
1. Group, Family and Individual Therapy
- Patients describe “Process” as the most challenging, and yet the most rewarding, group. Contrary to common concerns about patient’s “learning bad habits,” the properly supervised group experience plays an essential role in treatment and is a vital part of recovery.
- Group process is a minimally structured community experience that challenges and improves the individual’s ability to maintain an awareness of herself and peers while exploring her/his eating disorder and the underlying issues.
- At Valenta, “Process” is the most significant group in helping to increase self-exploration by recognizing and then challenging their established patterns of relating to others. This is crucial to recovery as the Eating Disorder frequently distorts relationships or isolates the patient from supports.
- The group setting helps patients and their peers challenge isolation by identifying their automatic perceptions and behaviors and openly sharing them. Process group is a place where patients build trust with others and themselves.
- There is a “dynamic interplay” between the patients where they eventually can recognize and shape their “social microcosm” (Yalom 2005).
- Patients challenge their own and their peers’ distorted thinking, destructive behaviors and ineffective choices.
- Patients keep themselves and their peers accountable, support and encourage one another.
Primary therapists work to educate patients and families or other social supports about the dynamics of recovery. A primary objective is to consolidate family support for the patient and to help families address the factors that allow the Eating Disorder to exist within the family system. Adolescents participate in a required family/support session once a week and, in addition, attend the multi-family night once a week. We also require parents to attend weekly family education groups to help increase knowledge and understanding of the Eating Disorder and the family role, to increase healthy communication, and to plan for aftercare. Adults can choose to receive one optional family/support session a week. We recommend members of adult families or supporting individuals attend these family education sessions, which are led by Valenta’s expert staff.
Family Education Topics:
- Nutrition: Teaches families about the importance of balance in meals and portion sizes, uses experientials to help parents prepare for difficult meals, and answers questions from families about ways to support their loved one.
- The Development of the Disorder: Explore how the Eating Disorder develops in individuals using developmental theory and family types.
- Communication: Explores communication styles, identifies unhealthy forms of communication, and teaches healthy and assertive ways to communicate within families.
- Relapse Prevention: Teaches families about the importance of relapse prevention planning even at the beginning of treatment. Topics will include the recovery cycle, aftercare planning, ways to identify relapse, and communication of needs and wants during recovery.
- Survival Skills: Explore ways the families can utilize resources in the community, advocate with their insurance, and practice their own self-care while caring for their loved one. Educational DVD: Families and adolescents watch an educational film that follows the recoveries of four women with Eating Disorders. Afterwards, families discuss and process the video and the impact of the Eating Disorder in their own lives.
The psychiatrist, primary therapists, and dietitians schedule individual sessions to supplement the work done through groups. A unique aspect of Valenta is the opportunity to work closely with the psychiatrist on a daily basis in a therapeutic relationship. The dietitian will meet with the patient multiple times per week and therapists will have longer individual sessions with patients one to three times weekly. Interventions used include cognitive-behavioral therapy, psychodynamic therapy, insight-oriented therapy, attachment therapy, EMDR, mentalization based therapy, behavioral therapy, motivational therapy, narrative therapy, emotion-focused therapy, systems therapy, psycho-education, and skills training.
2. Psychotherapy Modalities
Cognitive-Behavioral Therapy (CBT)
Dialectical Behavioral Therapy (DBT)
Mentalization Based Treatment (MBT)
Eye Movement Desensitization and Reprocessing (EMDR)
Art and expressive therapy
Progressive Muscle Relaxation
Soul care groups
Nutritional counseling (family and individual)
Goals and coping skills
Exercise and activity
Social and Community Reintegration
Discharge planning and aftercare
Cognitive-Behavioral Therapy (CBT) groups are a core component of the program to help patients address the symptoms and cognitive distortions of their eating disorders. CBT groups occur almost daily with reinforcement throughout the therapeutic program. Rational Emotive Behavioral Therapy, by Albert Ellis, is the foundation for basic CBT techniques to help patients recognize the connection between their thoughts, feelings and behaviors, to dispute/replace irrational or distorted thinking and to choose healthier behaviors.
At Valenta, CBT will help patients learn and understand how emotions, thoughts, and behaviors work together. With the help of program, patients will also learn how to manage difficult emotions, challenge distorted thinking, and use healthier coping skills.
While CBT is an important therapeutic tool and helpful in Eating Disorder recovery, it alone is not sufficient for achieving recovery. It is the mix of modalities that makes Valenta unique among eating disorder clinics. At Valenta, CBT groups occur four times per week.
Dialectical Behavioral Therapy (DBT) is a methodology developed by Marsha Linehan in which standard cognitive-behavioral techniques for emotion regulation and rational thinking are combined with more Eastern principles, such as mindfulness, distress tolerance, and acceptance of self. Valenta utilizes DBT to help patients become more aware of their own thinking as well as conceptualize how others think. Valenta also uses DBT to help patients connect with their body, work through grief and shame, and gain insight into how to better tolerate emotions.
At Valenta, DBT is incorporated into CBT groups and is used by therapists with patients individually.
Mentalization Based Treatment (MBT) is an innovative form of psychodynamic psychotherapy developed and manualized by Peter Fonagy and Anthony Bateman. Already it is validated for the treatment of Borderline Personality Disorder; the core concepts of mentalizing are extremely useful in helping understand and address major issues associated with an Eating Disorder. Mentalizing has been described as “keeping the mind in mind” shifting attention away from just the content of an interaction to the process of how intentional mental states guide our emotional and interpersonal relationships. Additional concepts from mentalization offer remarkable insights on how the Eating Disorder can twist the way we think and react to situations from concrete perceptions of food and weight and complex issues of self-concept to communication with our family and community. Attachment theory, one of the most well researched and grounded theories in psychiatry, provides the evidence base and foundation for utilizing this exceptional therapeutic tool. Valenta is one of the first Eating Disorder Programs to incorporate this innovative therapy.
Eye Movement Desensitization and Reprocessing (EMDR) is one of three scientifically validated trauma therapies. It is an information processing therapy and uses an eight phase approach to address the underlying experiential contributors to a wide range of issues. It attends to the past experiences that have set the groundwork for current problems; the current situations that trigger dysfunctional emotions, beliefs and sensations; and the positive experience needed to enhance future adaptive behaviors and mental health.
- Valenta follows a philosophy that to “Be Powerful” patients must be able to access their full inner workings. Trauma and dissociation prevent this due to fear and avoidance.
- There is clear scientific evidence that treatment and resolution of traumatic experiences and comorbid PTSD (Post Traumatic Stress Disorder) must be satisfactorily addressed to facilitate full recovery from the eating disorder.
- Between 60 to 85 percent of our clinical population eventually identify or disclose various traumatic experiences that contribute to or exacerbate the Eating Disorder.
- EMDR is one of our most valuable tools we apply in treatment. With this technique, we have been able to identify and treat trauma, including complex and prolonged traumatic experiences. This often restores trust, hope and a sense of accomplishment to patients who were ready to give up.
- In addition to EMDR, we have the knowledge and experience to use exposure therapy and CBT, the other validated trauma therapies, to assist our patients in working through past adverse life experiences.
- PHP/IOP treatment options both provide the duration of interaction to initiate the trauma recovery process.
At Valenta, we believe it is critical patients be assisted in stabilizing, grounding, and developing trust prior to working through the fear, shame, guilt, anger and other symptoms of traumatic experiences.
Valenta’s Approach to EMDR:
- EMDR is a validated trauma therapy that is an important adjunct to our treatment process. It is used to address core traumas including interpersonal trauma when there has been a “threat to the sense of self.”
- In our experience, EMDR is the most effective tool to address developmental and attachment traumas. To be effective, it relies on therapeutic rapport and trust.
- The technique allows for increased patient privacy regarding traumatic events and accelerates the process of recovery.
- All current Valenta therapists and the medical director are skilled at EMDR and perform it in 60- to 90-minute sessions.
- The treatment and therapeutic sessions are specific to the patient’s individual recovery process.
At Valenta, EMDR is used during individual sessions as appropriate for each patient in conjunction with their individualized treatment plan.
Patients engage in multiple therapeutic projects designed to assess and treat patients. Self-exploration through non-verbal media helps increase personal insight as well as insight into the Eating Disorder. Group members then assist in processing their peer’s art giving the patient a different “voice.” Often we have experiences or feelings that are hard to articulate, but art therapy helps patients explain and illuminate these experiences.
Some art activities patients engage in at Valenta include drawing/ expressing emotions, expressing feelings about body through art, describing history of body image through art, developing personal coat of arms, nature walks/drawings, designing a mask that represents external and internal features, and many other individualized activities.
At Valenta, art and expressive groups occur three times per week.
Sand-tray therapy is a dynamic and expressive form of psychotherapy that allows patients to express their inner worlds through symbol and metaphor. Sand tray therapy provides an experience that is active, nonverbal, indirect, and symbolic. This is essential when the patient has an experience that is hard to express or may involve a non-verbal memory. The scene creation phase, in which patients arrange their miniatures in the tray, is very important and is central to the sand-tray therapy experience. However, the processing phase provides an additional experience that builds upon the scene creation phase and allows the patient to look at their scene and experience the impact of it.
Sand-tray therapy is used during individual sessions as appropriate for each patient.
Body image groups are typically part of Eating Disorder programs to explore, challenge, and correct visual and environmental distortions of one’s body. At Valenta, we go beyond body image and help patients move away from focusing on visual distortions alone to an awareness of emotions, beliefs, and experiences within their bodies.
Body Concepts group is one place where you will be able to discuss thoughts, feelings, and behaviors that are related to what you think of yourself and your body. Body Concepts incorporates CBT, DBT, and art to explore the patient’s relationship with their body.
One of the main goals of Body Concepts is to help patients develop a better understanding of themselves, their relationship with their body, and begin to incorporate a whole sense of self. This means they will begin to not only to appreciate what their bodies can do physically, but also how it interacts with their internalized self, passions, dreams, desires, thoughts, feelings, and understanding of life and themselves.
Body Concepts groups are designed to help patients challenge distortions and develop a more realistic perception of their body. It helps them develop a healthy body concept that incorporates emotional, cognitive, physical, and spiritual experiences rather than just external appearances. Along with other groups, Body Concepts helps patients reconnect their body and mind to allow them have to have new experiences.
Body Concepts groups occur three times per week at Valenta.
Stress management is commonly used to help decrease symptoms that arise when stress is present. At Valenta, we go beyond simply teaching healthy coping skills to a deeper understanding of why the patient is stressed, the sources of that stress and how to incorporate their new skills into tolerating and resolving the stress. We help them understand their thought processes related to stress and help them change their ways of dealing with stressors when they arise.
Valenta combines the following modalities to help patients manage stress:
- Yoga and movement therapy, relaxation and progressive muscle relaxation (PMR).
- CBT skills to challenge distortions that coincide with increased stress.
- Anger management skills, such as deep breathing, taking a break, using reflective listening skills, and using “I Feel” statements to appropriately express anger.
- Discuss in CBT groups and Anger Management groups to explore the purpose of emotions and how they benefit us and how they can be misused. The groups also incorporate appropriate expression of emotions and specific use of coping skills to tolerate and assert themselves in obtaining relief and resolution.
- Combine these techniques with the increased awareness of stressors and their responses, both mentally and physically to the world. (Mentalization, Group Process and other therapeutic modalities)
Anger Management group occurs one time per week.
Valenta uses Yoga to help patients ground and accept their physical self while finding new nonverbal means of self-expression. It helps facilitate understanding and application of nonverbal experiences. Yoga also helps patients find different ways to move their bodies while facilitating ways to relax and create a sense of calm.
During yoga, patients learn the importance of the mind-body connection and establish a sense of grounding in the presence of external stimuli while breathing, posing and stretching. Through yoga, they are able to identify tension, increase relaxation skills, and improve flexibility while remaining present in the moment.
The following are some goals of Yoga:
- Improve patient’s ability to help facilitate calm and relaxation.
- Increase awareness of the body.
- Increase patient’s awareness and use of body’s ability to express emotion.
- Re-integrate the body into the sense of self.
- Development of new skills for patients to use to remain grounded for all groups.
- Using relaxing, centering, and calming techniques to provide a foundation for movement.
Yoga group occurs one time per week at Valenta. It is a core component of the program and a technique we hope our patients will incorporate in their lives.
During movement group, patients experience the integration of their internal dialogues and outward expressions through the structure of music and movement. The goal is to increase self-expression, creativity, and an enriched relationship with their bodies.
Movement therapists apply concepts of movement theories (Kestenburg) to help patients and staff identify areas of problems and understand patient development. Movement is a tool in the assessment process; to monitor a patient’s progression of self-acceptance through understanding of movement and their body’s expression. It also helps normalize trauma responses beyond the freeze, flight, fight or fright responses of trauma, creating a more accurate understanding of themselves (mentalizing vs. psychic-equivalence, or restriction of flow).
Movement helps one understand trauma responses in the body and the relationship with Eating Disorder behaviors. Likewise, it is an emotional release versus a “false release,” or expression, so it can help create a new understanding of self, while integrating other expressive therapies (art, etc).
During Movement, patients will develop new expressions of self that do not require a conscious understanding.
Movement group occurs at least once per week at Valenta.
Self-care is often an extremely difficult task for each of us. Life becomes so busy with work, school, family, and friends that we often forget about taking care of ourselves. For those with Eating Disorders, it can be even more difficult to find time to take care of yourself in the midst of the Eating disorder or when it may be perceived as selfish or self-centered. At Valenta, we work towards finding a balance of taking care of yourself and taking care of others. We want to help patients find a place for themselves when they are busy, stressed, or tired. We help them do this in various aspects of treatment, but Self-Care is explicitly designed to help patients learn how to better care for themselves.
Self-care group occurs three times per week at Valenta.
Patients are exposed to different techniques of relaxation in an effort to reduce stress and increase self-management within the safe environment of program. Through the experience, patients become increasingly aware of their hypervigilance and how to appropriately deal with these issues. This group occurs one to two times per week.
Patients learn and practice various skills designed to increase awareness of their immediate mood and physical state and to enhance their ability to distinguish between these states. The treatment team also assists the patient to better manage sensory stimulation from their environment. Through mindfulness, patients will increase their ability to regulate mood, decrease anxiety and to remain grounded despite managing internal or external distress.
Patients learn about the importance of nurturing their spirituality. The groups are designed to increase meaning, purpose, and hope. Group discussions are tailored to the questions of current group members but frequent topics include: grace, freedom, mercy, forgiveness, shame, guilt, perfectionism, motivation, and values.
Soul care groups occur one time per week.
At Valenta, we understand that an element of healthy living is one’s spirituality; the piece of us that looks beyond the material world and touches our beliefs and hopes. Research has found that most people who achieve recovery report that their own spirituality was a significant part of their journey. Effective treatment must address physical, mental, relational, and spiritual health.
While our program is not connected to any one particular religious group, most of our patients express a connection to the Judeo-Christian faith and our program’s core concepts are consistent with these principles. The objective of this track is to assist patients in identifying and exploring their own beliefs and hopes. We acknowledge that this is a personal matter and are here to listen to and assist you in clarifying your own beliefs and values. Incorporating these personal principles into your daily life will provide a strong foundation for your treatment and recovery.
Each week patients may attend a Soul Care group that encourages them to explore the concepts listed below:
- Purpose – Purpose is one of our program’s Core Concepts. Clarifying one’s own views on the purpose of life in general, and our own lives, specifically, is quite helpful as one battles the pull of the Eating Disorder’s demands to follow it.
- Truth – Truth refers to a formalized position on what is of ultimate value. Knowing what source of information we use as our basis for determining value is important if we are to build a strong and healthy foundation for our lives.
- Tradition – Tradition refers to practices and activities that one engages in consistently which express and reinforce one’s beliefs.
- Community – Community refers to relationships we build that are forged from the common ground of shared beliefs. The individuals in one’s spiritual community provide the relationships through which we demonstrate our values.
Life Skills groups are designed to help adult patients develop and or enhance skills needed for daily living. Many of the adult patients who attend Valenta are students or young adults beginning a new stage in life. Transitions can be difficult and can often trigger lapses in recovery. Life Skills groups discuss and teach techniques and skills helpful for pursuing a healthy, well balanced, and powerful life.
- Cohabitation, communication, assertiveness training: Patients learn ways to assertively express their needs and wants while living/communicating with others.
- Budgeting: Patients learn about how to open bank accounts, save, use debit/credit cards, fill out financial aid forms for higher education, manage finances, etc.
- Professionalism: Patients learn how to create a resume and attend job interviews.
- Socialization: Patients often isolate and have very little social contact. Patients will learn how to meet others, possible places to meet others, and ways to start up conversations.
- Nutrition/Cooking: Patients will learn how to grocery shop, cook for the week, cook for a family, and plan meals around busy schedules. This often includes actual experiences shopping or cooking.
Life Skills group occurs at least once per week.
As appropriate for the age and cognitive ability of the patient, the treatment staff may incorporate alternate forms of expressive therapy from dance to sand tray therapy. These are determined individually for patients to reach specific therapeutic goals.
Being healthy is not just about eating the right types of foods or the number on the scale; it includes both emotional and physical health. The key to helping an individual with an Eating Disorder reach and maintain optimal health, as well as freedom, is to help them understand the relationship between their emotions and food intake. Here at Valenta, patients not only learn portion sizes and food groups but they also learn what food does for their body and how it can affect their emotional and physical health. This is accomplished by individual meetings with a registered dietitian and groups that focus on education, life experiences and utilization of healthy coping skills. The goal is to identify and challenge unhealthy rules and food beliefs that keep one from experiencing freedom with food.
A few examples of what makes nutrition at Valenta unique:
- Interaction between dietitian and therapist to identify and help increase awareness of how food intake is related to life challenges.
- Monthly themed parties to practice social eating.
- Cooking experiential classes to help with preparing food at home.
- Moving towards health educational program to learn the role food plays on the body.
Adolescent parents are required to attend a weekly family night which include a parent education groups. Nutrition groups are included in the rotation of groups. We encourage adult families/supports to attend parent education groups to increase knowledge and insight into ways to appropriately support their loved one in recovery.
A Registered Dietitian (RD) also meets with families individually to answer questions, give feedback, help families be aware of changes in meal plans, and provide nutrition information. RDs are available by phone and e-mail to answer questions as well.
Each meal plan is developed to meet the specific needs of the patient. The meal plan will change throughout treatment to make sure that nutritional needs are being met.
Nutritional group occurs three times per week.
Goals Group is a structured way of helping patients set smaller goals within the larger goal of recovery. It allows patients to recognize steps they are taking to achieve health/power in their lives. It also provides for a sense of accomplishment as they start to recognize how they achieve their weekly goals.
At the beginning of each week, patients set goals for the week, identifying everything from initiation, to small steps, to ways of overcoming roadblocks. Goals are concise and attainable within the week, with the long term goal of health. Patients set both nutritional and therapeutic goals. On the last day of the week, patients review how their weekly goals went and set weekend goals meant to be attainable over the weekend. Group members will review weekend goals when they return to program.
Goals group occurs twice per week.
This group is designed to help patients, in all stages of recovery, begin to look at how their Eating Disorder can manipulate and undermine recovery and ways they can overcome these challenges. The group discusses topics such as the recovery cycle, relapse prevention plan, coping skills, triggers, warning signs, and how they will transition back into life and seeing an outpatient treatment team.
Relapse Prevention group occurs once a week.
Activity can be a healthy part of a balanced lifestyle. Exercise and activity are evaluated on an individual basis to ensure they are done appropriately. Thoughts and beliefs regarding exercise and activity are discussed in individual sessions. The patient and treatment teamwork closely to create an exercise/activity plan that is healthy for where the patient is in treatment and physical health. This will change throughout the course of treatment.
We understand that being in a program for several weeks can make the transition back to life difficult. We help you reintegrate into your social, educational, or work environment to help you and your family slowly reintegrate back into your activities.
For adolescents, we work with the schools and counselors to help reintegrate the students as appropriate for increasing social activity and continuing academic education. We maintain contact with schools throughout a patient’s time in program to help ensure that the patient is receiving appropriate academic work while they attend the program.
As necessary, we help advocate for your educational opportunities and rights to educational assistance as you recover from this medical illness. Adult patients, who are students, receive similar support from the program. We act as a liaison between schools and our patients to help them continue their education and social activities as medically appropriate.
With patients who struggle socially, we help patients identify and attend social activities to increase social interaction and decrease isolation.
As you continue on your path to recovery and prepare to leave Valenta, we will work with you to identify appropriate therapists, psychiatrists and/or dietitian for your ongoing treatment. We strongly encourage you to have these relationships in place well before you leave Valenta.
Valenta also offers free weekly aftercare support group sessions for patients who have graduated from the program. They are divided into adult and adolescent groups and are offered on Mondays from 4-5 p.m.