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Research and Treatments
The Center for Change eating disorder treatment program is based on cutting-edge research into eating disorders. The Center also conducts and publishes its own research on eating disorders, including on-going treatment outcome research. As new innovations in treating disorders are proven effective in research, they are implemented to enhance the Center for Change treatment program.
In keeping with current research findings and clinical guidelines, and in order to provide the best possible services in the most cost-effective manner, Center for Change offers a multi-dimensional, multi-disciplinary, stepped-care treatment program. Each client who comes to the Center for treatment participates in an ongoing comprehensive assessment which begins with an evaluation of their physical status, eating disorder history, associated psychiatric disturbances, substance use patterns, developmental history, family history, and a thorough family interview. Based on this assessment, one or more levels of care will be recommended, depending on the severity of the client's symptoms and eating disorder.
ABOUT EATING DISORDERS AND TREATMENT
Eating disorders are characterized by severe disturbances in eating behavior. Bulimia Nervosa is characterized by repeated episodes of binge eating followed by unhealthy compensatory behaviors such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise. Anorexia Nervosa is characterized by a refusal to maintain a minimally normal body weight. An unhealthy and inaccurate self-view of body shape and weight is an essential feature of both Bulimia Nervosa, Anorexia Nervosa and Binge Eating Disorder.
Experience and research show that individual, group, and family therapy in a warm and loving setting is superior to the sterile, impersonal atmosphere found in many hospitals. The Center for Change facility contains semi-private rooms with baths, a family-style dining room, kitchen, comfortable common living areas, individual and group therapy rooms, family visiting rooms and professional offices. The design of the Center provides patients with privacy while the residential decor and attitude of the Center's specialized staff creates a warm, caring atmosphere.
The Center is situated on private property to afford maximum privacy and a magnificent view of the mountains. Grounds are beautifully landscaped to produce a peaceful, tranquil setting our clients can enjoy. Recreation areas are shielded by our building and offer adequate space to provide outside activities.
The Center's primary focus is the treatment of women suffering from anorexia nervosa, bulimia nervosa and binge eating disorder. Related characteristics treated include mal-nourishment, poor self-esteem, feelings of helplessness, family conflicts, and traumatic life events such as abuse and sexual trauma. Other co-existing disorders such as depression, substance abuse, anxiety and post traumatic stress disorder are also treated. Center for Change specializes in the treatment of women because they represent 90 - 95% of the population suffering from eating disorders. Many of the women treated have conditions that have progressed to the point where they are unable to function independently or effectively in their family, work, school or social settings. Center for Change can help with eating disorder treatment.
INVESTIGATION OF INTUITIVE EATING WITH PATIENTS IN AN EATING DISORDER INPATIENT TREATMENT PROGRAM: A TWO-YEAR PROSPECTIVE STUDY
Melissa Smith, Kimberly Passmore, P. Scott Richards, Steve Hawks and Hala Madanat
In 1995 the book, Intuitive Eating, by Evelyn Tribole and Elyse Resch was published. This book proposed an alternative approach to maintaining physical health for those stuck in the cycle of repeated, ineffective, and damaging yo-yo dieting. Intuitive eating is characterized by eating based on physiological hunger and satiety cues rather than situational and emotional cues. Several psychologists, nutritionists, and health science professionals have argued that this style of eating is adaptive and research studies have shown that it is associated with positive self-esteem, body image, and weight maintenance and/or loss, as well as reduced cardiovascular risk and greater pleasure and less anxiety associated with eating. Nevertheless, there is limited evidence concerning the effectiveness of intuitive eating with eating disorder patients. Controversy exists in the eating disorders field concerning the question of whether it is possible for patients with eating disorders to learn how to eat intuitively, and whether attempting to teach this skill is helpful or harmful. We conducted a two-year prospective study where we evaluated whether teaching intuitive eating to patients in an eating disorder inpatient treatment program was effective.
- Intuitive Eating Scale (IES; Hawkes, Madanat, & Merrill, 2004), 30-item
- Eating Attitudes Test (EAT) (Garner & Garfinkel, 1979), 40-item
- Body Shape Questionnaire (BSQ) (Cooper, Taylor, Cooper, and Fairburn, 1987), 34-item
- Outcome Questionnaire (OQ-45.2) (Lambert, Okiishi, Finch & Johnson, 1998)
- Theistic Spiritual Outcome Survey (TSOS; Richards, Smith), 17-item
Major Findings and Conclusions
- Significant improvements in eating disorder patients’ ability to engage in intuitive eating behaviors and attitudes.
- The analysis of the IES scores showed that the eating disorder patients’ scores significantly increased between the time they were admitted to the Inpatient treatment program and transitioned into the Residential treatment program. Their scores also significantly increased between the time that they began the Residential treatment program and at the time they were discharged from treatment.
- As a group, the patients’ increases in their ability to eat intuitively were large and clinically significant (the effect sizes were large and ranged from .68 to 1.44). The clinicians perceived that the patients’ attitudes about food grew healthier during treatment (the effect size was large—.89).
- Dieticians also perceived that the patients’ ability to eat intuitively improved during treatment, and that their attitudes toward food and eating became healthier during the course of treatment, although their estimates of patients’ progress on these issues were more reserved (effect sizes ranged from .29 to .58).
- Patients’ scores on the EAT, BSQ, OQ45.2, and TSOS all improved significantly between the time of admission and the time of discharge from the treatment program. These changes were large and clinically significant (three of the effect sizes were large and ranged from 1.02 to 1.91; the TSOS effect size was the only small one at .36).
- Patients’ scores on all of these measures at the time of discharge fell into normal ranges, or close to it.
- At the time patients were discharged from the treatment program, the Hawkes Intuitive Eating Scale (HIES) correlated significantly with other indicators of positive treatment outcomes, including reduced eating disorder symptoms (as measured by the EAT), improvements in patients’ perceptions of their body size and shape (as measured by the BSQ), reductions in psychological symptoms such as depression, anxiety, relationship conflict, and social role conflict (as measured by the OQ-45.2), and improvements in what patients felt about their spirituality and moral congruence (as measured by the TSOS).
- In summary, the findings of our 2-year prospective study provide strong evidence that intuitive eating behavior and attitudes can be taught and learned in an inpatient and residential eating disorder treatment program, and that improvements in patients’ ability to eat intuitively are associated with other important indicators of healing and recovery. That intuitive eating principles can be effectively integrated in a highly structured treatment in light of the many medical, nutritional, and psychological considerations, provides sound evidence for their incorporation in inpatient and residential eating disorder treatment.
Recommendations for Future Research
There is a need to investigate whether intuitive eating skills and attitudes can be learned as effectively for different types of eating disorder patients. For example, do patients with anorexia nervosa, bulimia nervosa, binge-eating disorder differ in their ability to acquire intuitive eating skills, attitudes, and behaviors? Are there differences between adolescent and adult patients in their ability to acquire intuitive eating skills, attitudes, and behaviors?
Cooper, P., Taylor, M., Cooper, Z., & Fairburn, C. (1987). The development and validation of the Body Shape Questionnaire. International Journal of Eating Disorders, 6 (4), 485-494.
Garner, D., & Garfinkel, P. (1979). The eating attitudes test: An index of the symptoms of anorexia nervosa. Psychological Medicine, 9 (2), 273-279.
Hawkes, S. R., Madanat, H. N., & Merrill, R. (2004). Intuitive eating, dietary composition, and the meaning of food in healthy weight promotion. American Journal of Health Education.
Lambert, M.J., Okiishi, J.C., Finch, A.E., & Johnson, L.D. (1998). Outcome assessment: From conceptualization to implementation. Professional Psychology: Research and Practice, 29(1), 63-70.
Richards, P. S., Smith, T. B., Schowalter, M., Richard, M., Berrett, M. E., & Hardman, R. K. (2007). Development and validation of the Theistic Spiritual Outcome Survey. Psychotherapy Research, 17, 643-655.
Melissa H. Smith, PhD, Center for Change, firstname.lastname@example.org
P. Scott Richards, PhD, Brigham Young University, email@example.com
Research was presented at the International Conference on Eating Disorders (ICED) of the Academy for Eating Disorders (AED) on May 2, 2013 in Montreal, Canada, and is in the process of being submitted for peer reviewed publication.