Intensive outpatient

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In this article

What is intensive outpatient (IOP)?

An intensive outpatient program (IOP) is typically for people with eating disorders who are stepping down from residential care or a partial hospitalization program (PHP), yet still need some structure and support. (1) IOP can also be the initial step for those beginning their eating disorder recovery journey who do not require around-the-clock hospitalization or residential care.

Attending an outpatient program doesn’t require overnight stays, like inpatient care. Instead, patients visit a specialized facility several times a week for a few hours, for treatment with a multidisciplinary team of nutritionists, therapists, and psychiatrists.

How to treat eating disorders with intensive outpatient (IOP)

The most suitable candidates for intensive outpatient care are those who are high-functioning in their disordered eating behavior. They are able to keep up with their day-to-day life with minimal support. 

During IOP, the patient, their treatment team, and their individual therapists work together to establish a treatment plan and recovery goals.

How are eating disorders treated with intensive outpatient (IOP)?

Treatment of eating disorders with intensive outpatient treatment (IOP) typically involves:

  • Supported meals
  • Nutritional counseling and education
  • Group therapy and/or individual therapy
  • Family group therapy
  • Psychoeducation for friends and family

Treatment programs and therapeutic approaches will vary between facilities. The type of therapy provided depends on what is the best fit for the individual. A tailored program may focus on dialectical behavior therapy (DBT), cognitive behavior therapy (CBT), family-based therapy (FBT), or a combination of the three.

What to expect in intensive outpatient (IOP)?

IOP usually runs between 3-7 days a week for around 3 hours per day in a facility specializing in the treatment of eating disorders. 

Staff experienced in eating disorders lead therapy groups, with each group having a different focus. Groups may include expression and art therapy, body image, cognitive behavior therapy, dialectical behavior therapy, self-esteem, nutritional education, and family. (2)

These groups allow individuals to meet others struggling with similar eating behaviors, while providing daily structure and support. The goal is to help guide a patient through treatment and minimize the risk of returning to old eating habits and thoughts. 

Supportive meals form a critical part of IOP. Nutrition counselors develop and adapt a meal plan as necessary. Typically, participants bring their own snacks or meals to sessions, but staff checks it to ensure it complies with the meal plan. Depending on the eating disorder being treated, individuals may also be required to weigh in several times a week to monitor progress.

IOP treatment durationIOP depends on the individual’s needs. Following discharge, individuals are typically able to attend aftercare group sessions with other participants of the program.

These aftercare sessions may take place once or twice a week. They can include a meal and a staff member from the clinical team to guide the group, work through concerns, and suggest talking points.

What are the benefits of intensive outpatient (IOP)?

Reintegration after residential treatment

IOP provides a middle ground between residential treatment or partial hospitalization and outpatient treatment. This can help patients feel more secure if they’re concerned about getting back into their life following inpatient treatment.

Implementation of skills immediately

IOP treatment allows someone to transfer the skills learned back to their home life immediately, which makes it more likely that treatment gains will be maintained. (3)

Engagement in day-to-day life

IOP allows people to continue to engage in current obligations and activities in their usual environment and still get the support they need. Some patients are able to attend school or work while they attend IOP treatment. 

Lower cost

In many cases, IOP is much less costly than more intensive treatments, like inpatient and residential treatment. This can make treatment more accessible to some and persuade insurance companies to cover the treatment.

Efficacy of intensive outpatient (IOP) in healing eating disorders

The use of IOP to treat those with eating disorders has been found to demonstrate significant improvements in eating disorder pathology. It may also help improve self-esteem, as seen in a 2009 study, where participants with bulimia nervosa (BN) showed marked improvements in total body attitudes. (4)

A retrospective review of patient files of adolescents with restrictive eating disorders found that over 70% of participants had a good or an intermediate outcome at the point of discharge from IOP. (5) They made significant improvements in weight gain, motivation to recover, eating disorder symptomatology, comorbid symptomatology, and quality of life.

Furthermore, IOP may produce long-term results. A study into IOP cognitive behavior therapy on underweight eating disorder patients showed that completers achieved significant weight regain, improvement of eating disorder symptoms, and better general psychopathology. Most of these improvements were maintained at six-month follow up. (6)

IOP for eating disorders at Within Health

At Within Health, we offer a new virtual treatment model for eating disorders that exists between PHP and IOP levels of care. Usually once people leave an IOP program, they will look to transition home, where the environment may be far less monitored and conducive to healing than the clinical setting. 

With our treatment model, clinicians stay with our patients every step of the way, treating people with eating disorders in their home environments, or wherever is comfortable for them. Our clinical care team can provide up to twelve hours of care for each patient, which includes time spent with them during meal preparation, meals, and movement activities. Call our team now to learn about how to get started, or for more information on our treatment models.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. McGuire, J., & McGuire, J. (2017, October 23). The difference between IOP and PHP eating disorder programs. Eating Disorder Hope. 
  2. McGuire, J., & McGuire, J. (2017, July 27). Eating disorder IOP treatment - A day in the life. Eating Disorder Hope. 
  3. Intensive outpatient treatment. Beat. (n.d.). Retrieved February 25, 2022, from https://www.beateatingdisorders.org.uk/about-beat/policy-work/intensive-outpatient-treatment/ 
  4. Cecile C. Exterkate, Patricia F. Vriesendorp, Cor A.J. de Jong, Body attitudes in patients with eating disorders at presentation and completion of intensive outpatient day treatment, Eating Behaviors. (2009) 10 (1): 16-21
  5. Simic, M, Stewart, CS, Eisler, I, et al. Intensive treatment program (ITP): A case series service evaluation of the effectiveness of day patient treatment for adolescents with a restrictive eating disorder. Int J Eat Disord. 2018; 51: 1261– 1269.
  6. Dalle Grave, R., Pasqualoni, E. & Calugi, S. (2008). Intensive Outpatient Cognitive Behaviour Therapy for Eating Disorder. Psihologijske teme, 17 (2), 313-327.

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