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A Brain-Based Approach to Eating Disorder Treatment
by Laura Hill, PhD
a Temperament-Based Therapy with Supports TBT-S
What is TBT-S?
Temperament Based Therapy with Supports (TBT-S) is a new eating disorder treatment approach that draws upon the biological nature of each person. It was initially called “NEW FED TR: Neurobiologically Based with Family Eating Disorders Trait Response” and then “5-Day treatment.” The new name, TBT-S, is based on the vision and research led by Walter Kaye, MD at the University of California, San Diego, USA. In May, 2018, the new name was confirmed by the core treatment developers and authors.
Temperament is an overall concept that addresses the underlying bases of one’s character, comprised of the genetics, neurobiological and personality traits that are fundamental to how one thinks, interacts, and responds. Other eating disorder (ED) treatments have overlooked temperament and focused on behavioral or cognitive and emotional symptoms, the outward expressions of one’s temperament. Symptoms of an illness come and go, but one’s temperament continues throughout life. If temperament is not taken into account, then relapse may be likely because one’s underlying traits and neurobiological responses have not been addressed which are maintaining the illness. Persons can change HOW their traits are expressed ranging from productive to destructive behaviors and thoughts. TBT-S helps eating disorder clients and their supports know the underlying biological contributing factors to their eating disorder illness; and how to begin to manage temperament for a more productive quality of life. TBT-S has been tested from 2014 to present (2019) primarily on adolescents and adults with forms or history of anorexia nervosa, with findings showing acceptability and feasibility in open trials. TBT-S could be applied to bulimia nervosa and binge eating disorder. Some of the clinical tools and information in this text apply to all eating disorders. However, BN and BED have not yet been tested for feasibility. TBT-S is the overall model that can address all eating disorders by focusing temperament and includes supports (family and/or friends).
What area the requirements for 26 homestudy CE credits?
26 homestudy CE credits. The Center for Balanced Living is approved by the American Psychological Association to sponsor continuing education for psychologists. The Center for Balanced Living maintains responsibility for this homestudy program and its content. Verify that your board recognizes credit from APA approved programs. Cost: $549, includes individual license of core text and supplemental materials If you have already purchased an individual license of the core text AND supplemental materials, you can purchase the CE add-on for $399. CEs are NOT available for multiple user licenses. REQUIREMENTS FOR SUCCESSFUL COMPLETION OF ACTIVITY Verify that your board recognizes CE credits from APA approved programs. • Purchase CE package through BrainBasedEatingDisorders.org.* • Read the text and examine the supplemental materials at your leisure. • When you are ready to compete the activity, use the link provided in your purchase confirmation email to access the Evaluation Survey. • Complete the Evaluation Survey indicating your level of satisfaction with the activity. Upon completion of the survey, you will automatically be redirected to the Post Test site. • Create a login for the Post Test site, so you can save and finish later, if needed, and attest to your identity.** • Complete the 156 question Post-Test. You must receive a score of 75% or higher to receive CE credits. If your score is below the passing mark, you can click on the option below your score to re-take the test. You can re-take it as many times as needed to achieve a passing score. • After achieving a passing score on the post-test, you will receive an option on the score page to download your certificate. This is certification of your 26 CE Credits. *Purchase will be verified. Sharing links is strictly prohibited. Only individuals who purchase the etext are eligible for CE Credit. Tests completed without a purchase will be invalidated and no credit recorded. **Under the ethical code of honesty, psychologists must not make statements that are false, misleading or deceptive. A false attestation regarding identity will be reported to the board as an ethical violation. Learning Objectives: Upon completion of this activity, participants will be able to: 1. Describe the limitations of historical “outside in” approaches to eating disorders. 2. Describe how a neurobiological model of anorexia nervosa better addresses some of the limitations in historical models of the illness 3. Use metaphors to explain, in plain English, the complex neurobiological phenomena that occur as part of anorexia nervosa to facilitate dissemination of this model to clients, families and the general public. 4. Recite genetic/heritability data for anorexia nervosa and some of its key symptoms. 5. Compile a list of temperamental factors (personality traits) associated with anorexia nervosa. 6. Incorporate existing temperamental factors into effective treatment planning for clients with anorexia nervosa. 7. Utilize the venus fly trap metaphor to describe the etiology of anorexia nervosa. 8. Describe current biological interventions for eating disorders and summarize the data supporting their limited effectiveness. 9. Describe the brain-based rationale for the vigorous use of client supports in treatment for persons with anorexia nervosa. 10. Incorporate family and other key supports into treatment planning and interventions for clients with anorexia nervosa. 11. List the key brain sites involved in anorexia nervosa. 12. Compare the differences in the functioning of key brain sites in individuals who have anorexia nervosa and those who do not. 13. Describe the relationship between restricting food intake and the neurobiological mechanisms that reinforce it. 14. Describe the relationship between self-induced vomiting and the neurobiological mechanisms that reinforce it. 15. Describe the components of the 5 Day Treatment model for anorexia nervosa. 16. Describe the rationale for major components of the 5 Day Treatment including the incorporation of family/supports, the use of psychoeducation regarding the brain-basis of anorexia, the incorporation of temperamental traits and the importance utilizing highly structured meal plan recommendations during treatment. 17. Analyze and critique the strength of evidence for the neurobiological model of anorexia nervosa. 18. Create a collaborative client behavioral agreement to create comprehensive, neurobiologically-informed treatment plans for clients with eating disorders. Commercial Support: No commercial support exists for the CE program, The Center for Balanced Living or the author. The content was funded in part by the 2014 Feeding Hope Grant from the National Eating Disorders Association. No commercial support or benefit for endorsement of products exists. For questions or concerns related to CE credit ONLY, contact lori.johnson@thecenterforbalancedliving.org
This 540 page, interactive book provides a foundation for and a detailed description of a brain-based treatment approach for eating disorders. The core text lays a foundation for a brain-basis for eating disorders, integrating neurobiological and biological research into ongoing, evidenced-based cognitive and behavioral treatment approaches. It offers a brain-based language that bridges the gap between research findings and treatment. The core text also gives a detailed explanation of a new brain-based treatment called “5-Day Treatment for Eating Disorders.” It is a 45 hour (one week) experiential and practical brain-based program for females and males with anorexia nervosa (AN), AN traits or OSFED with AN symptoms, ages 16 and above AND their family members or friends. Neurobiological research has been integrated into the treatment forms, program and treatment tools. It “treats to the traits” common in eating disorders. The treatment program is intended to jumpstarts treatment from multiple dimensions, with the aim to decrease higher levels of care and increase lower levels of treatment to maintain a more balanced and healthy lifestyle.
The Core Text The core text offers an historical context, theoretical models that shifts the paradigm for treatment and a detailed description of a brain-based eating disorder treatment approach. Additionally, it includes an in-text glossary (user can click on a word in the text to see the definition), a full set of references for all documents and Visible Body 3D software. Visible Body has partnered with The Center for Balanced Living to allow us to provide every user with a copy of their software, providing a more comprehensive understand of the brain and body. Supplemental Materials Video Trainings Client and Support Manual (170 pages) Brain-Based Clinical Tools with detailed descriptions and instructions. These tools are interactive and apply brain concepts to help clients and/or families to confront difficult issues and dynamics and provides a structural game like format to aid in resolution. Clinical Stories that can be told to bolster a clinical point with guidelines on how to tell clinical stores. PowerPoint slides and over 7 hours of lecture notes for the 5-Day Treatment. The lecture notes are outlined so the speaker can go into varying degrees of detail depending on interest or focus. Eating Disorders Question and Answer Game that has been updated over time integrating current research. It is a Jeopardy like game to help clients and supports learn basic eating disorder brain-based facts. Behavioral Agreement documents. Completed over 5 hours, one hour per day, this agreement allows the client to lead through a structured process to determine how, when, where and with whom each treatment goal is to be realized. It is the comprehensive treatment plan designed to apply to mental health standards. Client/support tool box Sample orientation packet for the program
Who is this text for?
The core text has been written for mental health professionals, medical providers and educators. Clients and family members who want to learn more about a brain-basis of eating disorders may also find the core text helpful. The Supplemental information is provided for professionals to use in treatment and educational settings to replicate treatment and evaluate outcomes. Although every detail of the complete treatment is provided, professionals may choose to implement the program in its entirety or integrate only parts of it into their practice. Please note that all the research data collected and included in this text are from the complete treatment program. Using only portions may produce varied results. All of the text and supplemental materials are protected under copyrights and require appropriate credit and citation.
Why Anorexia Nervosa as the primary focus?
Currently, there is no valid treatment for adults with anorexia nervosa. The 5-Day Treatment for Eating Disorders has been developed to respond to this significant gap in treatment.
How did this new 5-Day Treatment develop?
In 2012, Laura Hill, PhD, President & CEO of The Center for Balanced Living, met with Walter Kaye, MD, Director of the University of California at San Diego (UCSD) Eating Disorders Center for Treatment and Research, Stephanie Knatz Peck, PhD, Director of the UCSD adolescent Intensive Family Program (IFT) program and June Laing, PhD, psychologist in the UCSD adolescent IFT program, to explore the possibility of developing a one-week treatment for adults with anorexia nervosa drawing upon UCSD's one-week IFT for adolescents. Over the next two years, the treatment team at The Center for Balanced Living, led by Dr. Hill, developed the program with research feedback from the UCSD team and, fundamentally, from feedback from clients and their supports at both sites. Open trials began thanks to the 2014 National Eating Disorder Association (NEDA) Feeding Hope Grant. NEDA’s grant helped establish the foundation for the current outcome data and helped to serve as a basis for the information in this text. Gratitude goes to NEDA for their support and encouragement in the development of a brain-based eating disorder clinical treatment and text. See: https://www.nationaleatingdisorders.org/feedinghopefund. The 5-Day Treatment for Eating Disorders was piloted in May 2014 and has been undergoing continuous revisions through April 2017. The material and revisions have been developed from the following sources:
1. Brain-based research findings 2. Clinical Tools developed by Laura Hill, PhD. 3. UCSD’s research team, who helped validate and refine the clinical tools for accuracy when interpreting brain-based research. 4. Clients whose ongoing input and feedback helped inform, shape and refine the brain-based treatment tools, clinical information and neurobiological treatment “language.” 5. Supports (parents, husbands, wives, children, aunts, uncles, grandparents, friends and colleagues), who offered input and suggestions. The evolution of the 5-Day Treatment for Eating Disorders and the refining of the clinical tools has been and is interactive. A central premise for this new intervention is that it is a continuous interactive evolution verses a one-way intervention from therapist to clients and supports. The text is written detailing the program approach, integration of research, the tools developed and the dynamics of the program management.
Who has been involved in the 5-Day Treatment development?
Under the leadership of Dr. Laura Hill, The Center for Balanced Living developed this new treatment through a vital collaboration with The University of California, San Diego (UCSD) Eating Disorders Center for Treatment and Research. Walter Kaye, MD, Executive Director of UCSD Eating Disorder Clinic and Research, and Christina Wierenga, PhD, Associate Professor and Clinical Neuropsychologist in the Department of Psychiatry at UCSD and primary research investigator conducted the brain-based research and interpreted the outcome data of the program. Stephanie Knatz Peck, PhD, Director of the Intensive Family Program (IFT) at UCSD helped develop the format for the program. Laura Hill, PhD, developed the clinical tools and treatment details, incorporating input from the specialized teams at The Center for Balanced Living and UCSD. Clients and supports have been fundamentally involved by offering feedback that has served to refine the clinical tools and treatment methods. The Center for Balanced Living’s professional team, who have been implementing, testing and participating in the revisions of the program since 2014, includes: Jason McCray, PhD, Chief Clinical Officer; M Mullan, LPC, clinician in 5-Day Treatment for Eating Disorders; Erica Temes, BA, Psych Tech; Amber Scott, BA, Research Associate; Sonja Stotz, RD, LD, Director of Food and Nutrition and Lead Dietitian for the program; Summer Lawson, MS, MSW, LISW, APRN, PMHNP-BC, Nurse Practitioner; Chris Schultz, PMHNP-BC, Nurse Practitioner; and Jenifer Takats, MD, Medical Director.
Why an E-Text format?
This unique, interactive platform was developed specifically for The Center for Balanced Living to create and offer brain-based eating disorder information and a new brain-based treatment. This e-text is the first product on this platform and comes to the reader as a “live text,” allowing the reader to actively engage in the informational process. Edits and updates will be made as needed. The Center hopes this new type of textbook raises the bar in how on line resources can be provided and a precedent for evidence based standards.
How can I use the E-Text format?
The Core Text and Supplemental Materials provide a basic foundation of brain-based eating disorders research and treatment materials. Readers could approach the text by:
• Reading from the beginning to the end. • Going directly to a specific section, identified in the Table of Contents. • Clicking on glossary words in green to have an overlay definition arise. • Going directly to the complete, 170 page Client and Support Manual. • Going directly to the training videos for each clinical, brain-based tool. • Searching for a word and going directly to it throughout the text. • Recognizing that the materials and treatment must be totally read and used and acknowledging that parts may be applied. It is NOT all or nothing. • Recognizing that some of the information is repeated in the core text intentionally to assure if a person is reading one section that the section makes more sense by including some information that is explained in other areas of the text. • Using multiple sensory approaches visual, auditory, touch. • Going to the open trial qualitative and quantitative treatment outcomes, based on the 45 hour, one week intervention.
What is the cost?
Purchase of the Core Text or Core Text PLUS Supplemental Materials grants you a license for the materials. The license is limited to the number of persons in the license agreement. An
Individual User is defined as one person, one individualized private practice or one family. The individual user agrees to use the material only within an individual practice or within a single family, not an extended practice or an extended family.
Multiple Users is defined as multiple professionals or families using the text at private practices, education programs, treatment programs or organizations, and family or other sites. This requires a multiple user license to purchase and use the text. It is a
violation of the License Agreement to purchase an individual license to share with or copy materials for other people and is subject to penalties. If multiple people would like access to the information, purchase the appropriate Multiple User license
Purchase Options 1. Core Text ONLY (comes with Visible Body software) Purchase of the Core Text ONLY allows online access and download capabilities of the text. Videos and documents can be viewed online but are not downloadable or able to be used for treatment/education purposes outside reading of the text. 2. Core Text (including VisibleBody software) PLUS all the Supplemental Materials for use in treatment. Purchase of the Core Text PLUS Supplemental Materials allows online access and download capabilities of the text. It also includes a file containing all of the videos, PowerPoint slides, lecture notes and documents that can be used for treatment/education purposes. 3. Oops Supplemental Add On Add on is for those who originally purchased the Core Text ONLY and now would like the Supplemental Materials as well. This option is ONLY available if a license/multiple licenses was purchased previously. License code REQUIRED at checkout to purchase this add on option. Individual user $90 for Core Text ONLY $150 for core text PLUS Supplemental Materials Multiple users 2-5 users $87.75/user for Core Text ONLY $146.25/user for Core Text PLUS Supplemental Materials 6-10 users $85.50 for Core Text ONLY $142.50/user for Core Text PLUS Supplemental Materials 11+ users $84.15/user for Core Text ONLY $140.25/user for Core Text PLUS Supplemental Materials Oops Add On of Supplemental Materials Individual user $120
How do I purchase the e-text?
Click on Paypal Icon. You will receive license to view book and Visible Body software via email.
Issues with purchasing? Send us an e-mail at ebook@brainbasedeatingdisorders.org |
| E-Text Core + All SUPPLEMENTAL MATERIALS (540 pgs. total): 1 copy | $70.00 per book |