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A multimodal therapeutic program starts during the inpatient stay and on occasion patients step down to partial hospitalization for continued treatment.
With a high staff-to-patient ratio, the therapeutic program is comprehensive and intense. Staff from each discipline, including psychiatry and psychology, social work, nursing, occupational therapy, and recreation therapy, all have expertise in the treatment of patients with eating disorders and contribute to the development of treatment goals and interventions for each patient.
Therapeutic modalities, which are described in depth below, include:
- Individual psychotherapy
- Family therapy
- Parent support group
- Psychotherapy process group
- Eating disorder group therapy
- Cognitive assertion group
- Body image group
- Relaxation group
- Mindfulness meditation
- Occupational therapy
- Recreation therapy
- Pharmacotherapy, as needed
Every patient in the inpatient or partial hospitalization eating disorders program meets with his or her psychotherapist three times per week. The focus of individual therapy is identifying and exploring psychosocial issues that influence the patient's sense of self and in turn impact levels of functioning at home or school, and in interpersonal relationships. Patients become aware that they have been using maladaptive eating behaviors to cope with difficult emotions or with stressors, instead of using appropriate, healthy coping strategies. Through individual psychotherapy, the patient gains an awareness of the relationship between maladaptive eating behaviors and emotional factors, and how to modify eating behaviors while simultaneously developing more adaptive strategies for coping with stressors and preventing relapse.
Family therapy explores the structure of the family and the relationships among family members, and aims to enhance the direct communication of thoughts and feelings among family members. The emphasis of family therapy for the patient is on attainment and expression of a sense of self that is distinct from that of other members of the family while maintaining a sense of family cohesion.
Parent Support Group
A psychoeducational group for parents of our patients is held once a week. Led by our inpatient nursing staff, this group addresses parents' questions and concerns regarding eating disorders and the treatment process, and also provides an opportunity for obtaining support from other parents.
Psychotherapy Process Group
The psychotherapy process group provides an opportunity for patients to collectively explore issues that are meaningful to the group. Many of the issues that arise in group psychotherapy are similar to the issues that arise in individual psychotherapy. By interacting as part of a group, the patient is able to practice interpersonal skills, experience group support and validation, and participate in the generation of solutions to common concerns.
Eating Disorder Group Therapy
This group focuses on the relationships between issues of daily living and eating disorder symptoms and behaviors. Patients are encouraged to examine the nature of their eating disorders and the ways that each individual's disorder is used to manage significant life issues such as relationships, achievement, feelings of dependency, self-doubt, and self-control. As the patient progresses in treatment, the eating disorder group therapy setting assumes a greater role in helping the patient to bridge the gap between externally supported eating behavior and self-regulated eating.
Cognitive Assertion Group
This group promotes the awareness and understanding of thoughts and feelings, as well as learned beliefs, as they relate to distressing situations. With this exploration, the negative automatic thoughts that interfere with self-perceptions, social interactions, and other activities of daily living can be identified. Corrective thinking is then developed and behavioral changes (for example, developing and practicing assertion skills) can be made, leading to improved coping and movement toward better functioning. The discussion allows for each individual to identify an area of difficulty in which he or she is motivated to create change, and feedback is provided by both peers and therapist. A log book is provided to each patient for independent reflection and to work toward the goals established in group.
Body Image Group
This group works toward identifying patterns of thought, behavior and relating with oneself that produce a negative body image, and toward making different choices to create new patterns with more positive responses. Activities and topic-related discussions in the group involve exploration of thoughts and feelings centered on body image and how body image influences one's mood, self-concept, and engagement in and/or avoidance of daily activities. Various strategies are taught to increase comfort with body image including corrective thinking, relaxation, problem-solving to cope with distressing situations, getting rid of clothing that does not fit/shopping for new clothes, and exposures to activities the patient has been avoiding.
Relaxation group offers instruction in variety of techniques that can be used to alleviate symptoms of stress, including guided imagery, awareness of breath, and listening to quiet music.
Mindfulness Meditation Group
This group promotes awareness of, and connection with, one's present experience; helps participants develop greater mind-body awareness; and reduces stress. Mindfulness meditation may include focus on the breath and/or on thoughts, emotions, physical sensations, or activities.
Occupational therapy helps the patient identify skills, interests, and capabilities, and to develop additional skills. Occupational therapy also includes art groups, in which patients have the opportunity to work on creative self-expression through participating in painting, drawing, and ceramics. In this setting, our occupational therapists assess patients' task performance and mediate areas of difficulty, such as problem-solving.
Recreation therapy focuses on developing leisure and interpersonal skills in a group setting. For patients with a history of excessive or compulsive exercise, emphasis is placed on helping the individual develop and practice a flexible program of moderate exercise. Participation in physically strenuous activities during recreation therapy is contingent upon reaching a weight at which exercise is appropriate and then continuing weight gain as needed.
The multidisciplinary assessment process for each patient in the program includes evaluation by a UCLA faculty psychiatrist to determine whether medication treatment is appropriate. This evaluation begins upon admission to inpatient treatment and is continued on an ongoing basis throughout the patient's stay in inpatient and partial hospitalization. Medication may be prescribed to target eating disorder symptoms and/or symptoms of other co-existing psychiatric disorders (e.g., depression, anxiety disorders).
A structured, individualized eating program is created for each patient during inpatient hospitalization.
Meals and snacks are prescribed by the team dietician in collaboration with the clinical nurse specialist to ensure adequate nourishment and facilitate weight restoration as needed. Following a comprehensive physical exam, each patient is assigned a target weight range; this is the minimally acceptable weight range that the patient must maintain to permit healthy physical and cognitive functioning. Meal and snack content is initially determined by the dietician. Patients then progress to completing their own menus. Meals and snacks are monitored by our program staff.
In addition to individual meetings with the dietician for nutrition education and meal planning, patients meet with the dietician as a group. This group format provides an arena for discussion and education regarding various aspects of management of e