Virtual Eating Disorder Treatment for College Students Heading Back to School

by Heather A. Dlugosz, MD, FAPA, CEDS; Rebecca Hansen, Ph.D.; and Anne Kubal, Ph.D., CEDS-S

More than 30 million people will suffer from symptoms of an eating disorder in their lifetime. And many young people who are in college experience symptoms every day.

With the need for quality eating disorder treatment, especially during the Covid-19 pandemic, Eating Recovery Center meets students where they’re at to doffer virtual treatment and support. Not only can students access free resources, such as eating disorder support groups, but many qualifying patients can receive the same exceptional care they would in a clinic from the comfort of their home.

Today we’re taking a deeper look at ERC’s virtual treatment programs that may help college-age students who are suffering.

How does virtual treatment for eating disorders work?

Dr. Heather A. Dlugosz: Virtual eating disorder treatment helps to remove the barriers that can keep patients with eating disorders from receiving treatment. It supports individuals, often in areas of the country where they otherwise would not have access to care or while away from their primary supports/treatment team, to engage in specialized treatment and practice skills in the setting where they are residing currently.  It provides more flexibility for individuals with time constraints due to work, school or family obligations, those that have other barriers to travelling to an onsite program and for those individuals that may be more reluctant to receive treatment in person.

Dr. Rebecca Hansen: Virtual treatment for eating disorders allows for continued care and connection during an extraordinary time. Virtual treatment has allowed continued, evidence-based care for patients who would otherwise not have access during the pandemic. Our goal is to remove barriers to seeking or continuing treatment.

How is it different than in-person treatment?

Dr. Dlugosz: Individuals receive the treatment at the level of care they are eligible for in the comfort of the space they are currently residing. There is no commute to programming so this may better fit an individual’s schedule to ensure treatment can be a priority. Individuals will be in small group sessions to maximize connection and their treatment experience and individual sessions with each of the member of their treatment team while on a HIPPA compliant virtual platform. They will have the opportunity to prepare meals independently in the space they reside in to support in building mastery of their meal plan and skill utilization in that environment which is key. As with our in-person treatment offerings, they will have a collaborative care team that focuses on individualized treatment plan development and meeting patients where they are at.

Dr. Hansen: Virtual treatment is similar to in-person treatment with a multidisciplinary team but allows connection with your treatment team virtually, in order to receive the support and structure of treatment. Like our in-person services, virtual options include individual, group and meal support. Virtual programming allows for connectivity in a time when connection is more important than ever. Most major insurance companies cover virtual services. Important factors to consider are that you will need access to a computer, tablet or smart phone, as well as a private space where you can attend groups and individual sessions.

Please describe what a patient can expect during virtual treatment.

Dr. Dlugosz: Once an individual makes the tough decision to commit to treatment and is assessed to be eligible for virtual treatment by our clinical assessment team, they will be connected with their virtual delivery group team. Individuals can expect to receive the same high quality of care we offer at in person programs while being able to practice their skills in their residing environment. We have a commitment to individualized care with evidence-based therapeutic modality incorporation and creativity with community building and connection in this unique offering.

Dr. Hansen: Prior to the start of programming, clients will participate in an orientation to the virtual program, in which they will receive materials detailing how to connect, what to expect, and how to optimize the group experience over virtual. They will also receive information about how to prepare for meals, group curriculum and materials before each group. Weekly weights are expected for Virtual IOP and can be obtained either by a friend of family member, or at the patient’s PCP. ERC also utilizes an app called Recovery Record that gives 24/7 access to the therapists and dietitian to record mood, food intake, etc., to help track behavior use throughout the week.

Additionally, we continue to offer monthly Family Therapy for friends and loved ones to continue learning about Eating Disorders. This is currently done virtually as well and is the second Friday of each month.

Our virtual treatment programs have been carefully designed and offer evidence-based treatment adapted for the virtual platform, based on outcome data and patient feedback. Our groups include treatment modalities such as Acceptance and Commitment Therapy, Dialectical and Behavioral Therapy, and Experiential Therapy, in addition to Process groups. Group sizes are limited to ensure an intimate experience. Should a patient need a higher level of care, we are continuing to offer in-person services for our Partial Hospitalization Program and our Residential Program.

Why is a college student a good candidate for this type of treatment?

Dr. Dlugosz: If eligible, based on clinical status and level of eating disorder behaviors, students may be great candidates for virtual treatment so that they can engage in treatment while maintaining in the school environment. Additionally, this type of treatment can support students enrolled in colleges and universities where they do not have local access to specialized eating disorder care on campus or when returning home that might not have had access to specialized care otherwise. Often student schedules are flexible, which also may allow for engagement in treatment concurrently.

Dr. Hansen: Many college students are returning home for the semester or year due to the pandemic or may be coming home for breaks between semesters. Virtual programming is a great way for first-time patients to experience a bit of what eating disorder treatment is like or help serve as a booster of sorts if they need some help getting back on track. Virtual programming also allows the convenience of students being able to more easily fit treatment into their school schedule, as treatment schedules are often flexible.

Dr. Anne Kubal: As a former University Counseling Center psychologist, I am acutely aware that many students attend colleges and universities that are a significant distance away from treatment centers, sometimes forcing them to feel as if they have to choose between leaving school to seek more intensive treatment or delaying treatment to remain in school. One of the benefits of virtual eating disorder treatment is that it allows college students to receive much needed treatment without needing to leave school or problem-solve transportation difficulties.

What types of treatment options are available online, and how does one choose which is right for them?

Dr. Dlugosz: We currently have, in some areas of the country, the option for Virtual Partial Hospitalization programs (VPHP), which run seven days a week and six hours per day.  We also have Virtual Intensive Outpatient programs (VIOP) in states where Eating Recovery Centers are located and through our affiliate program in other states to increase access to care. VIOP programs run three days per week and three hours per day.  We offer free assessments with master’s level clinicians from the clinical assessment team and they will help individuals to determine the most appropriate level of care based on a multitude of factors including level and intensity of engagement in eating disorder behaviors, medical status, support availabilities, co-morbidities including substance use and presence of safety related issues (suicidal, homicidal thoughts, self-harm urges and engagement, etc.) and others.

Dr. Hansen: There are several virtual treatment options available, so finding the right fit for a patient is so important. At ERC, we strive to help patients feel confident that they’ve made the right decision and feel supported in taking the next steps.

Some things to consider: ERC’s virtual programs offer patients treatment in the state where the patient is located. Therapists and dietitians have been working hard to obtain licensure throughout the U.S. In the rare event that ERC does not hold licensure in a patient’s state, we will advocate for reciprocity for the patient individually. ERC’s virtual programs utilize a secure digital platform that ensures all services are confidential, HIPAA compliant and secure.

What kind of commitment is required for treatment, especially during the holidays?

Dr. Dlugosz: Committing to treatment is essential anytime of the year, not just during the holidays, to support in building motivation for a sustainable, values-driven life in recovery.  It is, however, especially important during the holidays where historically there can be more anxiety with seeing family and friends, less structure, and social events focused on food.  This year, the pandemic may contribute to increased anxiety and isolation as well, which the eating disorder thrives on. The sooner an individual can make the commitment to treatment, the sooner they can receive the full benefit of the support and interventions they need. Oftentimes, students are on break during the holiday season which can allow them to commit to the process more fully.

Dr. Hansen: Typically, for any level of care, we ask for a minimum of two weeks to get started with treatment. More often, the general timeframe for IOP and PHP are between four-to-six weeks total but vary for each individual person. Each patient will work directly with their treatment team to decide on a timeframe that both fits with their life commitments and also meets their medical needs for treatment.

What makes ERC’s treatment programs stand out?

Dr. Dlugosz: We stand out because of our commitment to provide the highest quality of care to individuals with a focus on a comprehensive treatment of the patient using multiple evidence-based modalities including Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT) and Radically Open Dialectical Behavioral Therapy (RO-DBT).  Our team is composed of individuals with specialization in eating disorder treatment and their comorbidities as well as extensive training in tele behavioral health and ethics. We offer a vertically integrated health system to support patients where they are at and offer the flexibility to transition to more support if they require a higher dosage of care. The intensity of Virtual Partial Hospitalization Program (VPHP) which is in session seven days per week is different than even some on-site programs with other providers. We have a commitment to the education of family/supports and this is reflected in educational programming offerings as well as alumni opportunities to support an individual post discharge.

Dr. Hansen: I strongly believe what makes ERC’s programs stand out, specifically our virtual programs at this time, is the creativity, thought and consideration that staff have put in to make the virtual experiences as close to in-person experiences as possible. We worked hard to adapt some of the most favorite groups and have found ways to incorporate them into our virtual platform. We work extremely hard to maintain the same superior quality in our virtual services that we provide for our in-person services.

Why should someone who is struggling start treatment now rather than after the holidays?

Dr. Dlugosz: The decision to start treatment is the first step to living a values-driven life in recovery and probably one of the hardest steps in the recovery process because it is the one that threatens the eating disorder the most. Getting into treatment at the right level of care and dosage of treatment needed is essential for an individual to begin taking steps for a sustainable recovery. Being in treatment allows for validation from peers, support, structure and accountability when working hard to interrupt behaviors and gives an individual access to skill development and a multidisciplinary treatment team to partner with them.

Dr. Hansen: Holidays can be some of the most stressful times of the year for someone struggling with an eating disorder. Managing the stress and anxiety on their own can be overwhelming and seemingly impossible. By seeking support now rather than after the holidays, patients can have an opportunity to have help in preparing for holiday meals and traditions, to practice challenging situations and conversations that may come up with family and friends, and to create a plan for meals, snacks and breaks. Treatment before the holidays can also be helpful in talking together with family or loved ones along with the support of a therapist, in order to create a plan for the holiday.

Are there many college students struggling with eating disorders?

Dr. Dlugosz: The age range for a traditional college student coincides with the typical timeframe where eating disorders can develop. Additionally, many changes during this time frame occur including transitions to school sometimes far from home, academic pressures, being away from supports, body image pressures, exploring who one is, and finding out where one fits in the college/university setting can all create anxiety that some individuals turn to disordered eating behaviors to support with.  Unfortunately, many students don’t have access to the specialized care they need, may be scared to take the necessary steps to receive mental health services based on stigma or simply may not know their symptoms/behaviors are problematic or lead to serious medical complications.

Dr. Hansen: Eating disorders are extremely prevalent among college students but have a very low rate of students seeking help or treatment. The transition from home to college is characterized by loss and decreased structure. Feelings of loneliness, uncertainty about the future, and fear are all normal reactions to beginning college. Couple all of that with 2020 and experiencing college in the middle of a global pandemic, symptoms seem to be amplified and pronounced, now more than ever. Virtual programming allows college students the opportunity to take part in treatment, while lessening the stigma associated with doing so.

Why is it important to get treatment rather than navigating it alone?

Dr. Dlugosz: Eating disorders can be very isolating illnesses related to the shame that individuals often feel secondary to behavioral engagement and/or body image distress.  There is immense power in the validation that you are not alone in this process. Engaging in a treatment program built on the foundation of group treatment creates the space for that validation. Receiving psychoeducation on symptoms an individual is experiencing, exploring precipitating and perpetuating factors, how co-morbidities impact their disordered eating patterns in a safe setting where you can practice skills and vulnerability and know that others around you have had similar experiences helps to build self-compassion and motivation to maintain in treatment and build a sustainable recovery.

Dr. Hansen: It is so important to address concerns related to eating, or eating disorder behavior, sooner rather than later. In doing so, the patient is creating a support system of people experiencing similar things, at a time when they might feel most alone. Treatment will allow patients to interrupt maladaptive behavior quickly and be held accountable by their team. The isolation that we are seeing since March when the pandemic began is skyrocketing. It is important now, more than ever, to ask for support and begin connecting with others struggling with similar issues. Getting treatment now allows patients to connect with providers and the ability to create structure for meals and snacks, while also utilizing resources that offer connection.  

Learn more about virtual eating disorder treatment. 

Biographies

Heather A. Dlugosz, MD, FAPA, CEDS 

Dr. Dlugosz, an Eating Recovery Center, Cincinnati psychiatrist and Associate Medical Director of the Midwest Region for Eating Recovery Center and Pathlight Behavioral Health, has experience with the treatment of eating, mood and anxiety disorders in adolescents and adults. She has been with Eating Recovery Center since 2015, when the Ohio facility was opened. Dr. Dlugosz is board certified in Adult and Child and Adolescent Psychiatry and is a Fellow of the American Psychiatric Association and a Certified Eating Disorder Specialist (CEDS). She currently is a Volunteer Assistant Professor in the Department of Psychiatry at the University of Cincinnati College of Medicine. 

Dr. Dlugosz grew up in Northeast Ohio and received her bachelor’s degree from Albion College. She earned her M.D. from the University of Cincinnati College of Medicine, completed her adult psychiatric residency at University Hospital in Cincinnati, now the University of Cincinnati Medical Center and her Child and Adolescent Psychiatry Fellowship at Cincinnati Children’s Hospital Medical Center where she served as Chief Fellow. Dr. Dlugosz embraces a collaborative, patient centered approach to the assessment and treatment of patients and her broad experience in a variety of settings is a solid foundation for providing compassionate care to patients at all levels. 

Rebecca Hansen, Ph.D. 

Dr. Rebecca Hansen is the Clinical Manager of Eating Disorder Services at ERC and Pathlight in Chicago. She has worked with ERC since 2014 in all levels of care. She earned her Ph.D. in Counseling Psychology from Ball State University. She completed her internship at the University of Missouri-Columbia and completed her Post-doctoral Fellowship at Northwestern University’s Counseling and Psychological Services. Her clinical interest areas include eating disorders, relational issues, training and supervision. She utilizes a feminist, interpersonal approach in both supervisory and clinical work.

Anne Kubal, Ph.D., CEDS-S

Dr. Kubal the Director of Clinical Training at ERC and Pathlight in Illinois and oversees the practicum, intern, and postdoctoral fellow training programs.  She earned her master’s degree in Counseling Psychology at Northwestern University and received her Ph.D. in Counseling Psychology from Michigan State University.  She completed her postdoctoral fellowship at Northwestern University’s Counseling and Psychological Services, specializing in the treatment of eating disorders.  Her clinical and research interests include eating disorders, non-suicidal self-injury, perfectionism, relational issues, and supervision and training.

Dr. Kubal is a member of the American Psychological Association, Academy of Eating Disorders, and International Association of Eating Disorder Professionals (iaedp).  She is a Certified Eating Disorder Specialist through iaedp and is also an iaedp-approved supervisor. Dr. Kubal is the President of the Heartland iaedp chapter; she previously served as Vice President, Secretary, and Student Liaison Chairperson for the chapter.  She has presented at national and international conferences and teaches a graduate course on the treatment of eating disorders in the Certificate of Graduate Study in Eating Disorders and Obesity program at Northern Illinois University. She is a Health System Clinician at Northwestern University, Feinberg School of Medicine, and serves on the Intern Training Committee at Northwestern University.