2019 Eating Recovery Foundation Conference: Highlights and Recap
Day 1: Friday, October 11th, 2019
Day 1 – Opening Remarks
“Our mission is to take the very best care of patients, families, providers, and our teammates as we deliver the highest quality treatment for patients with eating disorders and mood disorders.”
Day one started with a savory breakfast as Ken Weiner, MD, CEDS, FAED, Executive Chairman and Founding Partner of ERC/Insight, shared the company’s updated mission (above).
Dr. Weiner also advised the audience, consisting largely of healthcare providers, that one of the most powerful roles they can play in their work is to “hold onto hope” and “believe in patients even when they don’t believe in themselves.”
Day 1 - General Session – Elizabeth Easton, PsyD; Adele Lafrance, PhD; Craig Johnson, PhD, CEDS, FAED – I Don’t Want My Parents Involved! Or Do I?: Conceptualizing and Addressing Resistance to Caregiver Involvement
“What if a patient doesn’t want their caregiver involved – and we can’t force it? How do we get around that issue?”
Dr. Elizabeth Easton and Dr. Adele Lafrance opened the conference with a powerful session exploring how to work with clients and patients resistant to having their families and caregivers involved in eating disorder treatment. The speakers also discussed why caregiver access is important and how family involvement in treatment is a powerful and important part of recovery.
Dr. Lafrance discussed possible reasons for resistance to caregiver involvement, sharing interventions that may increase the chance of accessing caregivers in therapy. One of the interventions Dr. Lafrance described was chair work; empty chairs can help clients activate their emotions so they can be processed and worked through.
Fear can detach an individual from their wisdom.
Dr. Easton reviewed a number of emotional blocks (shame, fear, helplessness) that can come up for clients and caregivers during treatment and how to work with these blocks.
Both speakers then explored ways that attendees can help their clients decrease the power of their fears and, instead, increase access to the wise, healthy part of the self — to determine the best path forward. By doing this, clinicians may have more potential to access families and caregivers for individual work or family work.
Once the caregiver is accessible, clinicians can choose to meet with the caregiver solo for one or more sessions while at the same time helping all parties prepare for potential difficulties.
Clinicians can also:
- Develop and plan specific goals for caregiver involvement
- Prepare caregivers for what may happen during session and post-session
- Review all possible outcomes, including the possibility that things don’t go well
What if the therapist is afraid of involving families due to a risk of conflict or making things worse?
Dr. Easton acknowledged that emotional blocks can come up for clinicians doing this challenging work, too, including Fear, Helplessness, Hopelessness, Shame, and Self-blame. With audience participation, the presenters dove deep into therapist resistance to caregiver involvement.
To conclude, the speakers discussed:
- Ways to understand caregiver resistance to being involved in their loved one’s treatment and how to use that for insight
- How therapists can address challenging behaviors from caregivers in the therapeutic process
- How to talk to clients about insight gained regarding caregivers
Learn more about Drs. Easton and Lafrance here.
Day 1 - Lunch Session - Anne Marie O’Melia, MS, MD, FAAP; Tim Gard, CSP, CPAE – The Battle Against Burnout
“We know stressful things are going to happen. Our perception of them is the key.”
Dr. Anne O’Melia and Tim Gard, motivational speaker, lightened the mood at the conference as they focused on the healing power of humor and how humor can help decrease stress and clinician burnout.
Dr. O’Melia discussed the current state of crisis that physicians and other healthcare workers are facing, including the fact that those working with difficult patient populations face an increased suicide risk. Dr. O’Melia offered coping strategies and reminded us of the importance of focusing on the “F” words when we feel burned out: Family, Friends, Focus, and Fun.
Tim Gard did an exceptional job demonstrating the healing power of humor and how it can help reduce provider burnout. He had the audience cracking up the entire time with his constant jokes and visual humor aids, showing how humor can help us deal with stress and make us feel so much better.
Tim left the audience with these wise words,
“Use humor to enhance and never diminish. Share humor with others when you start to get stressed out and talk about your stress with others.”
Learn more about Tim Gard here.
Day 1 - General Session – Afternoon - Philip S. Mehler, MD, FACP, FAED, CEDS – Pearls and Myths in the Medical Evaluation of Patients with Eating Disorders
“Food is the medicine for these patients. And what gets them across the finish line is your dedication, your inspiration, and your ability to ferret out the fact and the fiction.”
Dr. Philip Mehler, Founder and Executive Medical Director of ACUTE Center for Eating Disorders shared current common myths related to anorexia, atypical anorexia and Avoidant/Restrictive Food Intake Disorder (ARFID) as he advocated for more evidence-based interventions in eating disorder treatment.
Dr. Mehler touched on many trends and topics that today’s eating disorder providers are seeing on a regular basis. He discussed gluten-free diets and how the number of eating disorder patients on gluten-free diets is rising, while the incidence of celiac disease has not been rising. He described a test that can help practitioners determine if an eating disorder patient has a true wheat sensitivity — acknowledging that some individuals truly do have discomfort and reactions to wheat. Providers can run this test for their patients — and if patients do show a wheat sensitivity, these patients may actually have better outcomes by avoiding wheat in their diet.
Dr. Mehler discussed refeeding for eating disorder patients and noted the benefits of “starting low and going slow” to reduce the chances of the dreaded refeeding syndrome. He discussed the factors that affect how providers can determine a refeeding protocol. At ERC and ACUTE, he reported typically starting patients at 1600-1800 kcals and higher — typically leading to several pounds of weight gain per week without seeing refeeding syndrome.
Dr. Mehler discussed additional myths and addressed the realities in many areas, including:
- Weight suppression
- Cardiac issues
- Bone density
- Gut and brain health
Dr. Mehler reminded attendees of the importance of staying ever vigilant to counteract medical misinformationon the topics listed above and more.
Learn more about Dr. Mehler and ACUTE Center for Eating Disorders here.
Day 1 - Breakout Session, Afternoon - Karen Schneller, LMFT, CEDS; Casey Tallent, PhD; Kristie Uniacke, MS, RD, CEDRD-S – Integrating Telehealth Interventions in Eating Disorder Practice: Lessons from the Virtual Wild
“People like the virtual lifestyle; they like using services on their phones and computers. With virtual treatment, we are able to meet patients where they are and guide them to recovery.”
With its rapid growth and forecast, telehealth is undoubtedly the future of behavioral health treatment. Casey Tallent, PhD, Kristie Uniacke, MS, RD, & Karen Schneller, LMFT, CEDS gave an overview of telebehavioral health, discussing its many benefits and how clinicians can get started.
The speakers acknowledged that one of the greatest benefits of telebehavioral health is that it increases access to experienced clinicians and the right level of care for those who face barriers to treatment, particularly in small towns and on college campuses. Telehealth offerings can eliminate travel (even in urban areas, programs can take an hour or more each way to get there), allow students to stay in school, and offer greater accessibility.
Virtual therapy programs are often accepted well by patients and offer clinicians a chance to reach patients earlier in their illnesses, offering that patient a better chance of success in recovery.
The earlier we can get to a patient, the better the outcome.
New communication opportunities, including video calls, phone calls, emails, and texting, are making it possible for telehealth to offer patients contact with therapists during or outside of traditional working hours. Many telehealth apps are available to professionals to help make this approach more feasible. The group recommended that if clinicians do choose to use a telebehavioral health app, that they do their research. Ask: Who makes it? What features does it have? What do reviewers say?
The presenters gave real-world examples of ERC/Insight’s virtual intensive outpatient (Virtual IOP) program, noting that when patients can do therapy in their own homes, in their own safe spaces, in their comfy clothes, with pets and personal items, they often feel calm and are able to open up. Shy clients may become more interactive. Additionally, therapists can see into their clients’ home space which can inform their clinical work.
The presenters noted that at times there are some drawbacks to doing this work and recommended that professionals do the following:
- Conduct a Risk Assessment first (not all clients are good candidates)
- Be aware of laws and regulations, including management of protected health information
- Troubleshoot and know how to navigate technical problems
- Ensure privacy
- Verify client’s location at every point of contact
The speakers emphasized the importance of knowing state laws regarding licensure, telehealth laws, and professional liability insurance. The group also encouraged attendees to get certified in telehealth to learn more about the ethics and laws associated with this practice.
When it comes to eating disorder treatment, the group recommended that clinicians collaborate with an in-person team member that can collect vitals, weights and lab data on the patient. Not only will this be essential to recovery, but this helps clinicians forge relationships with outpatient providers in the community.
Learn more about ERC/Insight's Virtual Intensive Outpatient Program: eatingrecoverycenter.com/viop
Day 2: Saturday, October 12th, 2019 Lunch & Featured Keynote Speaker - Frank Warren, founder of the Post Secret Project
“I believe we all have at least one secret that could break your heart. Reminding ourselves of that can bring more compassion, empathy, and maybe more peace to the world.”
Frank Warren presented PostSecret Live as the Keynote Speaker on Day 2 of the conference. His touching, inspiring, humorous, and at times heartbreaking presentation featured Eating Recovery Center Recovery Ambassador Council (RAC) members sharing their own secrets, demonstrating the power and the release and the healing that comes when we share our secrets with trusted others.
We were blown away by the honesty and depth of emotions that came up in the room during Frank’s presentation. Frank Warren is founder of the PostSecret Project, author of 6 New York Times Bestselling Books and a recipient of a Mental Health Advocacy Lifetime Achievement Award.
Learn more about Frank Warren here.
Day 2 - Breakout Session – Afternoon - Elizabeth Curran, LCPC – Exposure and Response Therapy in the Treatment of School Refusal
“The more that children are out of school, the more their avoidance increases and the harder it is to get them back to school.”
Elizabeth Curran showed conference attendees how exposure and response prevention (ERP) can help clinicians working with young people that are exhibiting school refusal.
Curran discussed the reasons why adolescents tend to want to avoid school or refuse going altogether. While there are many factors that can leading to this, one of the big risk factors she focused on was anxiety. Young people may be anxious and avoid school due to wanting to avoid rejection, stressful tests, or negative outcomes.
This is where Exposure and Response Prevention can help: by slowly and gradually exposing young people to the event that is most distressing (taking a test, speaking in front of the class, etc.), clinicians can help them overcome their fears. The more that the students are exposed to the feared event, the easier it becomes to handle, or the more they learn coping skills to handle any distress. Eventually, the young person’s distress decreases.
Elizabeth Curran is Clinical Director of Child & Adolescent Services at our newest treatment center for children and adolescents in Northbrook, IL.
Learn more about Northbrook here.
Day 2 – General Session – Afternoon - Ralph Carson, LD, RD, PhD; Ovidio Bermudez, MD, FAAP, FSAHM, FAED, F.iaedp, CEDS – Adventures on the Alimentary Canal: How the Gut Bacteria and Our Food Choices Influence Mood States and Eating Disorder Behavior
Drs. Ralph Carson & Ovidio Bermudez did an outstanding job discussing the two brains — our “normal brain” and our gut, which is known as our “second brain.” The two presenters gave an overview of how stress, appetite, food, mood, depression, anxiety and eating disorders are all linked.
Dr. Ralph Carson started off by talking about the following things that affect our appetite for specific foods — noting that the most craved food is chocolate. Some of the things that contribute to our enjoyment of certain foods include:
- Mouth feel
- Crunch Effect – the sound and feel of a crunch
- Sitting vs standing (standing mutes taste)
- Temperature (when our temperature goes up, our appetite decreases)
- Our exposure to light during day and evening
Dr. Carson noted that the emotional center of the brain tends to drive our eating; we tend to crave either sweets (he calls them “Mama foods”) or salty (“Foods designed to cheer”). Dr. Carson also shared a number of tips that can help people reduce cravings and other emotional eating habits, like the following:
- Build awareness
- Eliminate cues
- Remove self from social situation
- Notice if one is eating because they are bored or to suppress emotions
- Wait 15 minutes to see if you are truly hungry
- Ask yourself if you would eat raw veggies; if you wouldn’t, you’re probably not truly hungry
Other strategies that help people manage cravings and reduce emotional eating include the following:
- Joyful movement
- A cup of tea
If emotional eating has turned into loss of control eating, psychotherapy can help correct neurocircuitry, address interpersonal issues, or resolve past trauma or other emotional wounds.
Dr. Ovidio Bermudez focused on the explosion of science and research into the gut and the microbiome, noting that when there is a breakdown in communication between the two brains, it can lead to both mood and abdominal disorders.
Noting the high prevalence of people with both psychiatric and GI symptoms, Dr. Bermudez pointed to some of the more common links:
- Stress, in particular, can increase inflammation and lead to depression
- Chronic stress – high cortisol levels – plays a role in depression and anxiety
- Leaky gut is also linked with depression (increased permeability of gut lining)
Unfortunately, there is no one-size-fits-all or easy fix to these issues. This is where more research is needed to look into effective treatments and interventions to address the food-mood link. This is a new area of science that is just starting to be understood and we anticipate that this science will greatly inform behavioral health and medicine in coming years.
Learn more about Dr. Carson and Dr. Bermudez.
From all of us here at Eating Recovery Center and Insight Behavioral Health Centers, we thank you for making #ERFcon2019 a fun, educational event full of connection and shared moments that we will certainly not forget!