What does binge eating treatment look like at Within and why? 

• Individual and group therapy sessions. Psychiatric assessment and treatment.
• Therapeutic group meals, nutritional therapy, coaching, and education. 
• Customized and flexible scheduling. Treatment based off client’s needs. 
• Meal delivery to ensure ERP. Exposures to grocery shopping, cooking, meal planning.
• Day and evening connectivity SMS chat, self-reporting check-ins, and digital tools.
• Remote patient monitoring tools. Blind weights and vitals. Beta testing the Ultra Human.
• Community “living room”, off-hours distress support.

Goals for treatment 

• Reconnect to hunger, fullness, and satiety to guide nutrition quality of life. 
• Enhance emotional regulation and self care practices.
• Adopting weight neutrality while increasing self-compassion and meaningfully empowering those impacted by binge eating to combat anti-fat bias and diet culture.
• Gaining peace with food, body, and movement.
• Exposure therapy and recognizing restrictive mindset and patterns.

Therapeutic interventions

• IFS based and interpersonal Psychotherapy
• Structured self-help 
• CBT-E (CBT enhanced for Eating Disorders)
• Interpersonal psychotherapy (IPT)
• DBT 
• Exposure therapy
  
  • Food restriction, movement patterns (joyful movement), self-care
• Psychoeducation and opportunities to practice Mindfulness, Mindful Eating, and Intuitive Eating
• Family therapy, family coaching, and family psychoeducation 

Group therapy 

• Beyond Binging Group
  
  • A safe place to explore relationship with food and bodies
  • Decreases shame and secrecy around binge eating and other behaviors
  • Enhance, develop, and support intentional self care practices 
• Recovery At Every Size (RAES)
  
  • Process therapy group meant to provide a safe space for folx in larger bodies to process body image distress, their lived experience of being in a larger body in medical settings and within the family system, struggles coming up in treatment, and a variety of other topics determined by what the group is presenting with as we move along in recovery in the direction of body liberation
  • Alumni offering of RAES

Weight neutral approach at Within

• Educating, acknowledging, and addressing  trauma of weight stigma 
• Addressing medical trauma and negligence of medical care due to weight stigma 
• Extensive psychoeducation for patients, family members, and healthcare providers in the patient’s life 
• Paradigm shift/deprogramming 
  
  • Our advocacy of patient’s needs is a powerful message around their worth and validity of their needs (self-psychology/corrective emotional experience)
  • Advocacy (double edge sword)
• BP monitoring devices fit all size needs
• Care is firmly grounded in a weight neutral approach 
• Nourishing the body and honoring the need to eat based on satiety cues, not just hunger and fullness
• Reinforcing the need to eat and recognizing the profoundly restrictive and shame based nature of BED  
• Emphasis on self-care practices vs. focus on weight 
• Milieu based social reinforcement is woven into clinical experience 
  • Group norms prohibit fatphobic language
  • Teaching patients how to advocate for themselves around negative food based messages and interference with their process of learning mindful eating 
• Group offerings: Liberation Lab and RAES

Nutrition therapy 

• Education on consistent and adequate nutrition 
• Psychoeducation on the binge/restrict cycle 
• Binge Eating Meal and Snack Support
  
  • Addressing restriction and offering exposures and habituation to binge (“unsafe” or “forbidden”) foods
  • Mindful and intuitive eating practices focusing on hunger, fullness and satiety experiences in the body
    
    • Skills and mindfulness to address dissociation
• Addressing executive functioning issues that interfere with meeting nutrition needs
• Practical considerations that have to do with meal planning, preparation , and prioritization

Movement

• Address movement avoidance and discussion of movement activities that are “life giving”
• Exploring the intentionality of movement as a means of expression and joy in the body
• Provide movement options for all bodies and capabilities 
• Exploring and deepening awareness of psychology of movement 
• Address the importance of allowing space that is absent of pressure to exercise 
  
  • Allow the essence of yourself to be re-surfaced and empowered
  • Soul vs. society pressure