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Q&A: Treatment During the Holidays with Dr. Kim Anderson

By Kim Anderson, PhD

Spending the holidays in treatment is not something that most people would hope to do. In fact, some families and individuals struggling with eating disorders will request to initiate treatment before or after the holiday season. For those already in higher levels of care, they understandably may seek to leave programs in order to be home in time for the holidays.

Although entering/staying in treatment during the holiday season can be a tough thing to do, it is often the right thing to do.

Kim Anderson, Ph.D., the Clinical Director at ERC Baltimore, offers in-depth responses about why treatment over the holidays is important and what a patient can expect.

Is there a risk when delaying treatment? 

We know through research and clinical experience that eating disorder treatment success may depend, in part, on making treatment a priority. For those in the early and middle stages of treatment, it is rarely recommended to delay or interrupt treatment. For instance, early intervention in particular has been associated with better treatment outcomes. This highlights the importance of initiating treatment as soon as possible – even during the holidays. 

Why should patients and their caretakers consider treatment during the holidays?

The eating disorder does not take a “holiday.” In fact, holidays often present additional and more intensified challenges for individuals and families (see next question). Therefore, holidays may actually be a good time for individuals to seek treatment or intensify treatment. Eating disorders are very serious conditions that require immediate and consistent intervention. In this regard, there is an urgency to address all psychological, medical, and social aspects of the illness. For children, adolescents, and young adults in college, the break in their academic schedule may actually provide a good opportunity to focus exclusively on treatment during the holidays.

Why can managing eating disorders during the holidays be challenging? 

The holidays appear to be related to an increase in stress for everyone, but for individuals struggling with eating disorders, this time of year can present a serious challenge. This is primarily related to the increased focus on food, family, and social gatherings. During holidays, the anxiety experienced on a daily basis by those with eating disorders is magnified. Many of the traditional events and experiences serve as cues or triggers for common symptoms such as a fear of weight gain, behaviors to manage weight (e.g., restrictive eating, binge-eating, purging) and a preoccupation with food and eating. There is no denying the fact that a huge part of the holiday season is the food.

Do certain holiday activities create an even more overwhelming challenge?

Daily meal preparations/baking, big dinners, parties, increased family gatherings, and travel can create a change in everyday structure. Maintaining a daily routine that is anchored in scheduled meals is often an important aspect of treatment. The lack of structure can become overwhelming, making it a challenge to follow prescribed meal plans and therapeutic activity scheduling. Because the holidays extend over several months (e.g., Halloween to New Year’s Day), individuals and families must cope with the increase in stress for a significant amount of time. This can become exhausting.

Are there certain triggers associated with the holidays? 

The holidays often create pressure related to personal (and others’) expectations. People have concerns about what others are thinking about them. They may feel like they are being watched and judged negatively during family events and parties. Family and friends may make comments regarding eating, appearance, and weight which can be triggering for some. The desire to present as “better” or “normal” can lead to secrecy and hiding symptoms – rather than asking for help.

Stress levels and eating disorder symptoms are often positively correlated. As stress increases during the holidays, individuals with eating disorders will turn more and more to the disordered behaviors as a means of coping. For some patients, avoidance of all holiday gatherings may seem like the solution. They may choose to avoid eating with others and situations where they feel evaluated by friends and family. Of course, this social avoidance only leads to increased eating disorder symptoms as well as depression and social isolation. Even when attending social gatherings, it can be very difficult to get enjoyment from the activities as some individuals may be distracted by their thoughts and impulses related to the eating disorder.

How can providers help patients stay on track? 

Discuss the importance of continuing/initiating treatment during the holidays with everyone you are seeing. It is often helpful to provide education about the problems associated with “pushing through” the holidays and/or taking a break from treatment. Clinicians have learned that doing so can be overwhelming, exhausting, and create extreme stress for those with eating disorders. It may help to be very clear about your recommendation to keep up with all aspects of treatment – especially during this stressful time. 

Should a provider change the patient’s recovery protocol during the holidays?

If you’re working with a child/adolescent using Family Based Treatment, continue the protocol as planned. It is helpful to discuss this with parents, explaining the importance of continuing the management of eating behavior (and all other behaviors being addressed) throughout the holiday season. Any break in treatment may provide an opportunity for the eating disorder to gain strength.

If the eating disorder is severe (characterized by severe symptoms, associated medical concerns, self-harm, etc.) and a higher level of care is indicated, it is recommended that arrangements be made immediately and according to clinical necessity – as usual. It would not be recommended to delay treatment for holidays or anything else.

How else can providers help patients during this stressful time?

Taking extra time to help individuals and families prepare for the holidays can be extremely helpful. During this time, you can create a solid plan for successfully navigating the increased number of activities, meals, social events, and emotional reactions.

Some strategies may include:
•    Reducing the number of scheduled events
•    Identifying specific support people to help at meals
•    Building in daily self-care
•    Creating a list of coping strategies 
•    Including family and support persons in the planning
•    Discussing the true meaning of the holidays – what makes it special, focusing on aspects of celebration that do not involve food, etc.
•    Utilizing therapeutic strategies to reduce perceived pressures and expectations, for example, thoughts of needing to please/impress others

Are ERC’s treatment programs modified for care during this time of year?

Treatment at an outpatient level of care will not look significantly different during the holidays. Ideally, treatment would continue uninterrupted and as planned. However, in the weeks leading up to the holidays, planning for identified holiday challenges will become a focus. Regardless of treatment approach, individuals and families will spend time with their treatment providers to develop a personalized strategy that will help ensure continued movement toward recovery during this stressful time.

Although treatment will not be modified per se, for those in a higher level of care (e.g., partial hospital, inpatient, or residential), the holidays will be incorporated into the therapy, daily programming, and activities. For example, patients may work on holiday-themed projects in art therapy. Exposure therapy may involve situations that are avoided during holidays (e.g., family gatherings, holiday foods). Cognitive therapy strategies may be implemented in order to help recognize and modify problematic attitudes related to holiday expectations and fears. Family therapy and visits may be increased in frequency during this time in order to provide additional support. 

How do the clinical teams at ERC address the struggle of treatment during the holiday season?

Clinical teams are very aware that the holidays will not be the same for those in a higher level of care. They may be away from their home and missing out on events and traditions. Although it is understood by all involved that recovery is the priority and intensive treatment is required at this point, it can be tough on patients and families. Clinical teams will work with the patients in the program to create as much of a holiday celebration as possible. This may include things like watching holiday movies during free time, deciding on a special holiday meal, or writing cards for each other.

 

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Kim Anderson, PhD

Dr. Kim Anderson is the Regional Clinical Director of the East Region at Eating Recovery Center/Pathlight Mood and Anxiety Center. She currently oversees clinical programming at both the ...

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