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Intensive Outpatient Program for Binge Eating Disorder

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The River Centre Clinic’s Intensive Outpatient Program (IOP) is 4 hours a day, 3-5 days a week, specifically designed for people with Binge Eating Disorder (BED). It includes the opportunity for low cost or free independent living (depending on the space availability) so that people from outside of our local community have the opportunity to receive the specialized care that they need. BED is characterized by eating abnormal amounts of food while feeling unable to stop and is sometimes referred to as “compulsive overeating.” Although BED can occur in those who are normal weight, as the cycle of binge eating cycle progresses, it often leads to unwanted weight gain and obesity which can indirectly fuel further compulsive overeating. This eating pattern is usually intertwined with a turbulent emotional mixture of shame, guilt, depression and anxiety. These negative feelings often lead the person struggling with BED to continue to use food to cope, creating a vicious cycle. There is evidence that individuals with BED display rates of emotional distress, impaired quality of life and medical problems that are similar to other eating disorder diagnoses. Individuals with BED respond well to psychological and nutritional rehabilitation treatment designed specifically to address this eating disorder.

Signs & Symptoms of Binge Eating Disorder

• Continually eating even when full
• Inability to stop eating or control what is eaten
• Disgust, guilt and shame over how much has been consumed
• Stockpiling food to consume secretly at a later time
• Eating normally in the presence of others but gorging when isolated
• Experiencing feelings of stress or anxiety that can only be relieved by eating
• Feelings of numbness or lack of sensation while bingeing
• Never experiencing satiation no matter the amount of food consumed

The consequences of binge eating disorder involve many physical, social, and emotional difficulties. Some of these complications are:

• Cardiovascular disease
• Type 2 Diabetes
• Insomnia or sleep apnea
• Hypertension
• Gallbladder disease
• Muscle and/or joint pain
• Gastrointestinal difficulties
• Depression and/or anxiety

Why IOP and not Partial Hospitalization?
While most patients with anorexia nervosa (AN) and bulimia nervosa (BN) require at least Partial Hospitalization (PHP) level of care to recover from their eating disorder, there is evidence that many people with BED can improve with less intensive IOP treatment. For those who do not improve in IOP, a period of time at a higher level of care (PHP or Adolescent Residential) is usually effective before stepping back down to IOP.

Goals of Treatment:

  • To stop binge eating
  • To improve attitudes toward weight and shape
  • To address psychological problems connected to the eating disorder
  • To address coexisting medical problems

Intensive Outpatient Program Overview

The IOP Program for Binge Eating Disorder is a 4-hour a day, 3-5 day-a-week program that provides sufficient intensity, structure, and monitoring to meet the needs of most female and male adults who suffer from BED. The IOP provides many therapeutic services offered at a higher level of care at a fraction of the cost. Treatment is tailored to each individual and includes individual, group, and family therapy, with emphasis on understanding and controlling overeating, meal planning, symptom reduction skills, and relapse prevention. It also offers training on emotional skills, social skills, assertiveness, and stress management techniques. Although the program is primarily group-based, each program participant receives one hour of individual treatment per week (may be broken into two ½ hour sessions). Meetings with a physician or dietitian are based on individual needs.

Program Hours

3-5 days-a-week
4 hours a day (2:30 pm to 6:30 pm)

Typical Daily Schedule

2:25 pm: Weigh-in and Debriefing
2:30 pm: Prepare/Eat Supervised snack
3:15 pm: Group therapy
4:45 pm: Break
5:00 pm: Dinner preparation and supervised meal
6:00 pm: Post-dinner wrap-up and group activities
6:30 pm: Program ends

Summary of Program Components

  • Psychological assessment and medical evaluation.
  • Education about biological and metabolic changes that occur with BED.
  • Individual counseling to identify the emotional, psychological, and interpersonal factors that led to the development and maintenance of the eating disorder.
  • Individualized treatment planning designed to identify treatment goals.
  • Group counseling by specially trained staff members who understand eating disorders.
  • Nutritional counseling to provide education about healthy eating and nutritional myths.
  • Structured eating (one snack and one meal daily) to facilitate the development of healthy, nutritious, and appropriate eating patterns.
  • Monitoring of diet, weight, and medical status.
  • Support from other program participants who also have eating disorders.
  • Support and information for relatives of program participants.

Initial Assessment

Before admission to IOP, River Centre Clinic conducts a comprehensive clinical assessment to gather information regarding the prospective program participant’s current symptom picture, history of eating problems, health history, family history, current and prior medications, and various questions about overall emotional and physical health. The clinic also obtains information forms and questionnaires completed by each client. Client information from both interviews and questionnaires is essential to ensure that we do not overlook important details of each client’s current situation or history. Before admission to IOP, individuals must receive a medical evaluation to determine their general health status. In most cases, program participants receive the medical evaluation from their personal physician.

Individualized Treatment Plan

In the first week after admission to IOP, each program participant receives an individualized treatment plan tailored to meet his or her unique needs, based on our ongoing assessment of problems and progress. This plan is developed based on the initial assessment, then applied within the framework of evidence-based treatment principles and protocols, and continually revised as changes occur during treatment. The treatment team works closely with each program participant to set realistic treatment goals, and staff members are available to patients to explain the rationale behind various aspects of treatment. While in the program, participants learn how to address the main symptoms of their eating disorder. They also learn how to identify and start resolving the emotional issues that have contributed to the development and maintenance of symptoms. Program participants and their families are encouraged to participate in the treatment plan’s development and evolution as changes occur throughout the treatment process.

Nutritional Rehabilitation

IOP treatment includes a nutritional component to help participants develop appropriate eating patterns that will lead to true control of the eating process. Since food and meal planning are key elements of nutritional rehabilitation, each patient has a food plan tailored to meet individual needs under a dietitian’s or physician’s supervision, and specially trained staff members supervise meal planning and meals. IOP provides one meal and a snack daily with the days per week varying from 3 to 5 depending on the needs of the participant. Staff members assist each participant in developing a food plan for weekends and other times outside of program hours.

Medical and Medication Services

One aspect of the IOP treatment plan is evaluating and addressing each participant’s ongoing medical needs, and is provided by our staff psychiatrist and consulting physicians. River Centre Clinic’s medication/somatic service provide medical interventions including physical assessment, prescription, or supervision of medication(s). This service is aimed at educating program participants who require medication so they may develop an understanding of their medication regimen and other health issues.

Psychological Therapies

The IOP treatment plan involves a mix of individual, group, and family therapy. The plan also encourages family visitation that is prearranged with clinical staff members.

Individual Therapy: Each IOP participant is assigned to one or two staff members for individual therapy meetings. One of the aims of individual therapy is to help these patients overcome some of the fears and inhibitions they might experience in a group setting.

Group Therapy: The IOP treatment plan places strong emphasis on group therapy because it provides an opportunity for patients to learn by interacting with other people who suffer from eating disorders. The group therapy format also plays a valuable role in recovery by providing hope, reassurance, and understanding. Nevertheless, our approach is very flexible. We recognize that some people take longer than others to feel comfortable in groups. We encourage program participants to express any concerns that they have about our treatment format so that our staff members can explain the rationale behind various aspects of treatment.

Family Therapy: River Centre Clinic encourages each IOP participant’s family to be involved as part of treatment. We can schedule family meetings or therapy sessions regularly or periodically, according to the patient’s individual treatment plan. Each patient’s individual treatment plan may change over the course of treatment.

Discharge Planning and Aftercare

Discharge planning is an ongoing process that begins upon admission to IOP. The IOP treatment team works closely with each program participant to set realistic treatment goals and develop an aftercare (continuing care) plan for applying the behavioral management, communication, and problem solving skills that have been effective in treatment. Aftercare involves a range of options including assisting program participants and their families who need referrals for additional treatment or support in their home communities.