Using a combination of evidence-based psychological, medical and nutritional therapies, we create a safe and supportive environment for patients to learn and practice integration of new skills to restore health and balance in life.
Work with adolescents is modified with the adolescent context and brain development in mind. Compassionate informed parent involvement is essential, especially at mealtime and provides the best chance for full recovery. If parents are unable to provide meal support, or have limited time or emotional resources, therapy focuses on individual work with the teen to develop self-directedness and commitment. Slower and supported transitions are key to relapse prevention. States of low motivation are the norm and can be addressed with strong parent support. Strategies which focus on the significant interpersonal and physical consequences of starvation and purging (peer isolation, muscle loss, sluggish metabolism, fertility problems and inability to complete college or participate in sports) can help increase motivation to change. Families learn to only allow participation in gym or sport when nutritional balance is established, return to sport and exercise should occur with supervision due to risk of metabolic or physical injury.
We cultivate mindfulness through breathing, compassion meditation, yoga, movement and mindfulness based or enhanced psychotherapists such as ACT and DBT in groups and individual work to increase focus, mind sight, presence and self-compassion. This focus will help reduce suffering related to comorbid psychiatric conditions as well (anxiety, depression, PTSD).
We recognize that fasting and chronic low available energy is a powerful neuromodulator. Hungry brain is a state of deprivation and toxicity. Life with a hungry brain is like being drunk. Sufferers become deskilled and unable to manage emotions, caught in the past or ruminating about the future. Patients lack autonomy when in this state and need structure and supported meals to recover. The malnutrition must be corrected before recovery can occur.
Our first goal of meal therapy is weight and nutritional restoration. The gut and liver are often compromised during early refeeding. Reflux, regurgitation, slowed emptying, malabsorption and constipation are common and should be treated as a sign or serious and ongoing damage related to low energy availability. Hormones are effected compromising blood flow to brain and gut as well as intracellular processes. Energy stores in the liver are depleted leading to hypoglycemia. These processes are toxic to brain and organs and can lead to life-long health concerns. Gradual reintroduction of food with nutritious foods, low residue diets is preferred, mindful of problems with motility and food sensitivity.
Intensive treatment is an opportunity to practice reintroducing food and committing to a regular pattern of eating. The priority is acceptance of a sustainable strategy of eating. Meal challenges, cooking and independent meals are an important part of practice prior to transition and should be continued to protect recovery. While in treatment, meals and snacks are monitored and carefully balanced to meet individual needs. Nutritional support and meal coaching is offered in various settings individually, in groups, cooking classes, and on restaurant outings. Grocery shopping, self-portioning and challenge outings with an experienced dietitian help build skills and independence.
Binge eating and craving are partly seen as a response to restriction and low energy availability. Restoration of a regular eating pattern is an important part of treatment. Habitual binge eating can become a response to emotional distress, hypo or hyper arousal, emerging as an attempt to self-regulate. Mindful eating exercises help increase the awareness of aspects of hunger and taste as well as focus attention on other aspects of hunger. Chain analysis to explore events, emotions, beliefs that preceded the binge can be helpful. Binge eating is associated with reward pathways and can be associated with contextual cueing. Environmental changes such as ridding the home of certain foods or avoiding situations associated with past binge eating is an intervention used early in the recovery process but after the cycle has been reduced, supported exposures to binge foods with response prevention is part of relapse prevention.
Vomiting and laxative abuse are common in eating disorders. Frequent vomiting complicates efforts to resist urges because of associated reflux, regurgitation and slow motility. In treatment support of patients after meals to help resist urges to vomit, we also strive to increase awareness of the damage vomiting and laxatives are causing. Hydration and electrolytes are monitored closely when purging is frequent.
At McCallum Place we introduce exercise into treatment to help with wellbeing and anxiety management, but only after in a positive energy balance. Food and exercise are important medicine. When medically stable, patients enjoy active groups such as yoga, fitness outings, daily walks and dance and movement therapy. Compulsivity in either area are addressed as a treatment target, helping patients learn to do something else when forced with compulsive urges.
We acknowledge body image distortion is a core symptom, of delusional proportion at times and brain based. In general, reducing body checking (mirrors and weights) is helpful. Exercises which illuminate the distortion and reminders that this will typically improve with treatment can help with acute distress. Therapies focused on self-acceptance can reduce judging and comparing mind sets that fuel the critical over focus on body size and shape. Yoga, walking, dance, sport and weight training can help reduce body dissatisfaction and are introduced with support.
We believe family education and support is extremely important and should be encouraged whenever possible. Family involvement is a key predictor of good outcomes. We help families understand the illness, along with signs of recovery and relapse. Our goal is to help families develop skills to support their loved one. Family members may struggle with many of the same eating, exercise and body image concerns. When this is the case, it is our goal to help families cultivate an awareness of challenges for recovery that their habits may pose. Loved ones are supported and welcomed in the treatment process by participating in therapy sessions, weekly family groups and monthly family days.
Outpatient Treatment Team
We cultivate strong collaborations with therapists in the community and nationwide. Recovery can be a long process, we hope to work closely with outpatient treatment teams, communicating progress, stuck points around core treatment goals and support needed after discharge.
Evidence-Based Treatment Therapies
Our therapists in St. Louis and Kansas City are credentialed in evidence based therapies, such as Maudsley (family-based treatment), interpersonal therapy, cognitive behavioral therapy and DBT, for eating disorders and co-occurring conditions. This ability to provide focused individual, group and family treatment across levels of care and our ability to treat patients with severe or complicated illness makes us a center of excellence and a high quality alternative to traditional inpatient or residential care.
In group work, we also integrate mindfulness training, yoga, pet-assisted therapies and expressive therapies to enhance well-being and help reduce risk of relapse. We are dedicated to following outcomes and find our patients do best when they are able to make a gradual transition to increasing independence.
If you or someone you know is struggling with an eating disorder, please contact McCallum Place for a free and confidential assessment. We will help you follow a personalized path to recovery.
Anorexia Treatment Philosophy
Eating disorders are complex illnesses. A perfectionist temperament, traumatic body based experience and family history may increase risk. Interventions targeting nutrition, mindset, emotion and behavior all are part of the treatment. Families are understandably confused about how to best support their loved ones. Family interventions and meal support are extremely important for successful treatment. Patients do better with a firm but supportive (not controlling or judging!) caring treatment team. We focus on this in our care at McCallum Place.
Individuals with eating disorders typically have trouble adjusting to change, or have problems with “set shift.” This means that adjusting to new circumstances such as new body size and shape, new social situations, moving away from home and even treatment transitions typically cause more distress, anxiety and confusion than you might expect. For this reason, adults going through life transitions, such as heading off to college, loss of a relationship or death of a parent may be more vulnerable to relapse.
Anorexia affects thinking, making it hard to see things in context. Patients do not see the big picture when it comes to their fears, behavior and health. They restrict and avoid fullness to avoid distress. Avoidance is a maladaptive strategy of coping with fears. In theory we should not avoid things that increase our chance of survival, health and wellbeing.
Patients with eating disorders may avoid accepting a natural body weight necessary to reverse the hungry brain mindset. They may avoid food groups that are necessary for a balanced diet and organ function or body sensations related to refeeding after a period of restriction such as fullness. Support to accept the discomfort and reintroduction of foods that have been omitted is an important component of treatment. Avoiding discomfort will always backfire as it will increase the vulnerability to uncomfortable sensations in the long run.
Cognitive reappraisal or thinking a different way about uncomfortable feelings can help to reduce the emotional reactivity that drives rigid and restrictive eating. Most of the evidence based therapies we use (i.e.: CBT, ACT, Exposure, etc.) directly target these concerns.
If you or someone you know may be struggling with an eating disorder like anorexia, please contact McCallum Place for a free and confidential assessment. We will help you follow a personalized path to recovery.