Pre-conference workshops - Thursday 25 August
1. Engaging Partners in Recovery - full day
by Cynthia M. Bulik
2. Dialectical Behavior Therapy for eating disorders: Treatment development for an adolescent population - full day
by Shelly Hindle
3. Medical Management of complex eating disorders patients - morning workshop
by Dr Juliet Berkeley
4. Binge Eating Disorder workshop - afternoon workshop
by Virginia McIntosh
Half day workshops include morning or afternoon tea only.
1. Engaging Partners in Recovery: From the Rolls Royce to the Holden Model
Over the past several years we have developed a suite of treatments that emerged from the observation that engaging families in treatment aids in recovery in youth with eating disorders. We wagered that the same might hold for adults if we could harness the support of partners to work toward recovery with patients. We developed Uniting Couples in the treatment of Anorexia Nervosa (UCAN) and UNiting couples In the treatment of Eating Disorders (UNITE BED and BN versions) to apply couple based cognitive behavioral therapy to the treatment of eating disorders. In this workshop I will first present the full scale approach of UCAN and UNITE (the Rolls Royce model), but also provide concrete guidance for clinicians who hope to incorporate work with partners into treatment for eating disorders but who have not yet received training in UCAN, UNITE, or couple therapy in general (the Holden model). This limited couple-based approach may have important applicability in inpatient, day patient, intensive outpatient, and outpatient settings and provide you with the necessary confidence to include couple-based interventions in your eating disorders treatment toolbox.
2. Dialectical Behavior Therapy for eating disorders: Treatment development for an adolescent population
The purpose of this workshop is to give participants an overview of DBT used to treat eating disorders in the adolescent population. This will include:
- Review of the current research literature, theoretical underpinnings, and rationale for using DBT to treat eating disorders
- Overview of DBT (including adolescent adaptations). Modes, modules, dialectics, validation, and the function of consultation team.
- Adaptations to DBT for the ED population – integrating FBT and CBT strategies into the treatment.
- Using DBT skills to specifically target ED symptoms and behaviours.
- Management of common therapy interfering behaviours
- Guidance around starting up DBT programs within specialist services and adapting existing DBT programs to treat eating disorders.
In the last two decades, there has been growing support for family-based treatment (FBT) approaches to adolescent eating disorders (ED). For the majority of adolescent patients, this treatment has worked well. However, there is a minority who do not respond well to standard treatment, and seem to need a more intensive outpatient approach. Commonly, these clients also exhibit multi-problematic, difficult to treat presentations and emotional dysregulation alongside complex family dynamics. Emerging literature indicates that this population may benefit from adaptations of Dialectical Behaviour Therapy (DBT).
The “Riding the Wave” program at the Kari Centre is a DBT intervention for 13-18 year olds based on Miller et al.’s adaptation of DBT for suicidal and emotionally dysregulated adolescents. In recent times, this program has been adapted for youth with eating disordered presentations in conjunction with emotional dysregulation. The outcome of this treatment adaption included a 28 week therapeutic program consisting of weekly individual therapy, weekly skills training group sessions, family sessions as required, and optional after-hours telephone consultation. Family members were involved in the treatment through parenting support and education sessions with a DBT family worker, DBT and FBT informed family therapy sessions, and attended all group skills training sessions. Several important challenges arose during the development and delivery of the program. The details of these, and the solutions that we generated, along with outcome measures will be discussed during the training.
Shelly Hindle is a clinical psychologist who has been working in Child and Adolescent Mental Health Services (CAMHS) in New Zealand for over 10 years. She currently practices at the Kari Centre, working with clients with high risk multidiagnostic presentations including eating disorders. Along with her training in Cognitive Behavioural Therapy (CBT) and Family Based Treatment (FBT) she has undertaken extensive training in Dialectical Behaviour Therapy (DBT) both within NZ and overseas, including attending trainings run by Marsha Linehan and colleagues.
Shelly provides both training and supervision around DBT for psychologists and teams. Alongside this, Shelly was the lead
researcher/developer of the Kari Centre Adolescent DBT program for eating disorder presentations (DBTE).
3. Medical Management of complex eating disorders patients
Workshop details pending
Dr Juliet Berkeley MB ChB, FRACP (Endocrinology, General and Acute Medicine) is the Clinical Director of Endocrinology and Diabetes Services, Physician in the Department of General Medicine and the South Island Eating Disorder Services (SIEDS), Canterbury District Health Board.
Dr Berkeley’s clinical interests are in metabolism and nutrition. She undertakes Diabetes, Adolescent Diabetes and interdisciplinary Diabetes High risk foot clinics at the diabetes centre. She has inpatient General Medicine team at Christchurch hospital. Dr Berkeley provides liaison between acute medical inpatient services and the SIEDS, holds weekly clinics at SIEDS and reviews inpatient as required. Her experience in metabolic medicine, reproductive endocrinology and metabolic bone disease gives her a unique perspective in the complex multidisciplinary care of patients with eating disorders.
Dr Berkeley completed her undergraduate training at Otago University Medical School, completed basic physician training in Dunedin, London and Christchurch, followed by advanced training in Christchurch and Dunedin. This was followed by 2 years of Research at the Edgar National Centre for Diabetes and Obesity Research, in conjunction with the Christchurch School of Medicine.
4. Everything you ever wanted to know about binge eating disorder but were afraid to ask
By Virginia McIntosh, psychologist at the Clinical Research Unit of the University of Otago, Christchurch & Canterbury District Health Board, Christchurch, New Zealand
While the eating disorders, anorexia nervosa and bulimia nervosa, are widely known, other eating disorders are less visible, and the overlaps and distinctions between the different eating- and weight-related disorders are not well known.
Bulimia nervosa (BN) and binge eating disorder (BED) share a pattern of binge eating, consumption of larger than normal amounts of food with a sense of loss of control. Usually there is substantial distress after binge eating, with the individual feeling guilty, regretful, disgusted and disparaging of herself. Whereas with bulimia nervosa attempts are made to compensate for overeating by subsequently engaging in activities designed to prevent weight gain such as restricting food intake, overexercising, or purging, in BED these activities do not occur. BED has been recognised as a distinct diagnosis with the publication of DSM-5.
Many individuals with BED have high weights, some very high, and with substantial functional and medical complications. The exact prevalence of binge eating among individuals with high weight is not known, however from clinical studies it appears that upwards of 30% of individuals with BMI>30 who seek help for weight loss report serious problems with binge eating.
The workshop will review diagnosis of BED, will discuss factors important in the aetiology of BED, will explore links between BED and high BMI including the impact on health, will review the evidence base for treatments for BED including psychological treatments, behavioural weight loss interventions, and abstinence and food addiction models.
New Christchurch research from a randomised controlled treatment trial for binge eating will be presented. The Christchurch study compares cognitive behavioural therapy (CBT) with an appetite-focused form of CBT, and schema therapy for binge eating.
Dr Virginia McIntosh is a Senior Lecturer and Clinical Psychologist with the Clinical Research Unit, a collaboration between the Department of Psychological Medicine, University of Otago, Christchurch, and the Canterbury District Health Board’s specialist mental health services. Gini has conducted clinical trials for eating disorders and depression, including a randomised controlled trial comparing traditional CBT, appetite focused CBT, and schema therapy for transdiagnostic binge eating, has adapted psychotherapies for the treatment of specific disorders (including IPT for anorexia nervosa and schema therapy for binge eating), and developed novel psychotherapies, such as specialist supportive clinical management for anorexia nervosa. Gini has research interests in psychotherapy effectiveness, the mechanisms of change and the non-specific elements of psychotherapy, diagnostic issues, and neuropsychological and neuroendocrine functioning in eating disorders, depression and anxiety.