Levels of care for exercise addiction
Excessive strenuous activity can have a dangerous impact on both a person’s mental and physical wellbeing. Defined by an unhealthy obsession with physical activity and fitness, exercise addiction puts a lot of strain on internal systems. A person may even need to be physically stabilized before they can proceed with further treatment.
As with most eating disorders, exercise addiction treatment can be addressed with many levels of care. Regimens span from long-term hospital stays to periodic check-ins, depending on how severely the disorder has affected someone.
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This type of treatment is reserved for the most severe cases of exercise addiction. People who need inpatient care are often in immediate physical or psychiatric danger, exhibiting signs like:
- Threatening suicide
- Rapidly worsening symptoms
- Flagging vital signs
In these life-threatening situations, inpatient care typically involves around the clock medical care that can include:
- Tube feeding
- Intravenous fluid drips
- 24/7 medical monitoring
A person will usually stay in inpatient care until their condition has stabilized, a process that can take anywhere from a few days to a few weeks. Once stable, they’re referred to the next level of care.
Residential care is where most people who receive inpatient care move to next. It may also serve as an entry point to exercise addiction treatment for many others. This option is appropriate for people who still need full-time access to care, or those who may not have healthy or stable home environments.
During this phase of treatment, patients live full-time at a treatment facility. Their care can include:
- 24/7 medical monitoring and access to medical attention
- Individual and group therapy sessions, which may focus on:
- Developing coping skills and strategies
- Nutrition and exercise education
- Interpersonal relationships and dynamics
- Meal and work-out supervision
While some focus still remains on further stabilizing patients at this point, many patients start long-term treatment plans during residential therapy. (2) Individualized treatment plans can include:
- Specific therapeutic recommendations
- Treatment schedules
- Medication management options
There’s no prescribed timeline for residential treatment. Patients may stay in a program for several weeks or up to a year before they’re ready to move on.
Partial hospitalization program (PHP)
A subsequent step down from residential treatment is a partial hospitalization program (PHP).
This level of care is a transitional phase in exercise addiction treatment, where patients spend the day at a treatment center but return home at night.
Also called “day programs,” PHPs are optimal for people who still need substantive help but are ready to start practicing their new skills outside the hospital setting.
Care at this stage can include:
- Continued individual or group therapy
- Continued medication monitoring and management
- Activity monitoring
- Nutrition counseling
- Supervised meals
Patients participate in care five or six days a week for four to six weeks, total. (2)
Intensive outpatient (IOP)
Intensive outpatient programs (IOP) are for patients who still need regular medical check-ins but are ready to spend more time at home.
These types of programs typically run three to five days per week, with patients spending three to five hours per day receiving treatment. (2)
IOPs offer the opportunity to begin returning to work, school, and other social situations, as patients at this level of care are able to manage themselves more independently.
Ongoing care for someone seeking exercise addiction treatment at this level may include:
- Group or individual therapy sessions
- Supervised meals or physical activities
- Nutrition or exercise counseling
While the length of these programs is determined on a case-by-case basis, most intensive outpatient sessions go on for between four to six weeks. (2)
The final step for some and first step for others on the road to recovery from exercise addiction is outpatient treatment.
This level of care is appropriate for mild cases of people whose symptoms are well in hand but who could still benefit from periodic medical check-ins. Typically, outpatient treatments include:
- Ongoing individual or group therapy sessions
- Exercise or nutrition counseling
- Medication monitoring and management
However, a person receiving outpatient care has shown the capacity to handle the stressors of a regular social schedule without concern of relapse. And, most importantly, people receiving outpatient care have demonstrated the commitment to continuing to heal.
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Psychotherapy for exercise addiction
Almost all forms of exercise addiction treatment will include some type of psychotherapy. But, just as there are varying levels of care for exercise addiction, there are many psychotherapy approaches used to treat it.
No one type of therapy is better than another. It will depend on what best suits the individual’s needs.
Cognitive behavioral therapy (CBT)
The evidence-based therapy most recommended for a number of eating disorders, cognitive behavioral therapy (CBT) aims to combat these disorders by changing unhelpful thought and behavioral patterns related to them. (3)
A highly-structured type of therapy, CBT follows a general pattern of sessions focusing on several major concepts, including: (4)
- Better understanding problematic thoughts, emotions, and behaviors
- Analyzing the underlying factors behind those thoughts, emotions, and behaviors
- Learning problem-solving skills to help cope with stressors in a healthier way
- Learning self-monitoring techniques to continue healing after CBT is over
Cognitive behavioral therapy can be helpful for those struggling with exercise addiction, as the technique focuses on what’s presently going on in a person’s life, rather than what may or may not have led them to where they are.
Acceptance and commitment therapy (ACT)
Acceptance and commitment therapy (ACT) has the same overall goal as CBT—that is, helping a patient change unhelpful thought and behavior patterns—but takes an almost opposite approach to reach that target.
Rather than actively trying to change all related thoughts and behaviors, the goal of ACT is to simply acknowledge, accept, and let go of limiting thoughts, emotion, or behaviors, because suppressing unhelpful emotions at the peak of a vicious cycle will cause even more undue stress. And, for people struggling with exercise addiction, who turn to exercise to deal with stress, learning how to manage stress in another way is important.
Cognitive remediation therapy (CRT)
Commonly used in conjunction with other types of therapy, cognitive remediation therapy (CRT) doesn’t focus as much on directly changing thoughts and habits as it does on building up certain thinking skills, including: (5)
- Working memory
- Executive function
Strengthening each of these areas is helpful on its own. But, together, they can help patients work to adjust patterns of inflexible thinking, which are thought to drive many disorders.
Seeing the world less as a place of absolutes may help a person struggling with exercise addiction realize that it’s okay to miss a workout here or there, or to take it easier on themselves, which can be an inroads to deeper healing.
Dialectical behavior therapy (DBT)
Many disorders, including exercise addiction, often have ties to or are triggered by the way people handle stress. Dialectical behavior therapy (DBT) gets straight to the heart of the matter by teaching patients different types of stress coping mechanisms and skills, including:
- Mindfulness skills
- Distress tolerance
- Emotion regulation
- Interpersonal effectiveness, or how a person communicates with others
Another focus of DBT is expanding someone’s cognitive flexibility. In fact, the word “dialectics” actually refers to the analysis of contradictions. In therapy sessions, this may be used by encouraging a patient to understand two points of view at once. This can help the person see the world as a place of “both-and” scenarios, rather than “either-or” ones. (6)
Exposure therapy works essentially as it sounds: by bringing someone into contact with a situation or thing they fear. For a person struggling with exercise addiction, this might include a day without a workout.
Not all encounters need to be made face-to-face. Exposure therapy can also be performed:
- Through visualizations or imagination
- By physical simulations
The thinking behind this modality is twofold: showing people they can overcome unpleasant situations and helping them better manage their anxieties.
Family-based therapy is a type of therapy involving therapy sessions with family members.
Not all family members need to attend every session, and they don’t even need to attend together. It’s also possible for family members to see a therapist individually.
Still, at its heart, family therapy focuses on the different dynamics and communication styles within a family unit, with goals that can ultimately include: (7)
- Building stronger relationships
- Creating healthier home environments
- Solving family issues
- Understanding unique strengths or weaknesses of each family unit
For someone struggling with exercise addiction, family therapy can be a helpful tool to build a stronger support system; get everyone on the same page, in terms of the best ways to encourage recovery; and help eliminate any temptations or triggers that may impact the patient at home.
Involving multiple people and one or several therapists facilitating the group, the idea behind the group therapy is for people to help each other heal by sharing their thoughts and experiences with others who may have similar thoughts and experiences.
Groups can either be open to anyone—like Alcoholics Anonymous—or closed, involving a set group of patients who all take the sessions together.
This form of therapy carries a number of benefits, as well, including:
- Building support groups
- Offering a sense of catharsis
- Expanding a patient’s perspective
- Giving a safe space to practice new skills
People seeking exercise addiction treatment may find it helpful to hear from others who are going through, or have gotten through, similar struggles.
Interpersonal therapy (IPT)
At its broadest scope, interpersonal therapy (IPT) examines a person’s role in society and how it impacts their thoughts and behaviors. More specifically, IPT looks at that role in times of transition, including when someone:
- Gets married
- Gets divorced
- Experiences the death of a loved one
- Becomes a parent
Even when these events are positive, they can trigger stress as they bring change into a person’s life and dynamic in society. IPT helps patients understand and adjust to those changes, by targeting specific problems and developing solutions to them. (7)
Nutrition counseling and meal support
Nutrition counseling and meal support are important aspects of treatment plans for many types of disorders, including exercise addiction.
These sessions may be individual or part of a group and involve meeting with a dietician, nutritionist, or nurse about eating habits and food.
Sessions may address issues like the importance of getting enough vitamins, minerals, and calories or offer strategies, such as how to institute a meal plan. Counselors may sit with patients while they eat a meal to monitor a patient’s progress, offer support, and help instill a more regular eating schedule.
When seeking exercise addiction treatment, nutrition counseling can also play a crucial role. Despite often appearing in shape, many people struggling with this disorder have been found to frequently have poor nutrition and other eating disorder symptoms. (8)
Experiential treatments for exercise addiction
Psychotherapy is perhaps the most widely-used therapeutic tool for helping people overcome difficult disorders, but it’s not the only one. There are also a number of experiential treatments that may offer some relief.
Rather than focus on speaking about and analyzing issues, experiential treatments encourage patients to use different forms of self-expression to get their feelings out, including:
- Drawing and painting
- Acting (psychodrama)
- Music—playing, listening, and writing
The idea is to bypass the left side of the brain, which controls more logical functions, and tap into the more creative right side, which also plays a key role in using emotions and the senses.
Freed from using verbal language to explain their feelings, a patient can experience a number of benefits from this type of treatment, including:
- Tapping into previously unknown emotions about an issue
- Using different forms of communication
- Broadening both their and their therapists’ perspective
For people struggling with exercise addiction, these types of programs can also offer different outlets for channeling their excess energy or stress, rather than relying on the gym or their workout routine.
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Treating exercise addiction at Within Health
Exercise addiction can disrupt a person’s life and do serious damage to the body. Because our society is so focused on fitness, it may be hard to recognize there’s a problem, and even harder to ask for help. But the compassionate team of professionals at Within Health is here to help every step of the way. We offer virtual care programs for anyone who may need help in treating exercise addiction, or co-occurring eating disorders.
With the proper care and commitment to wellbeing, recovery from this disorder is possible.