Occupational Therapy Health Management Program Design for Individuals with Eating Disorders Carissa Gualano | doctor of OCCUPATIONAL therapy program | Huntington University, Fort wayne location
Outcomes for OT Impacting Treatment for Patient's with Eating Disorders and Co-Occurring Mental Health Concerns
- Educate other professions on the benefits of health management skills interventions for individuals with eating disorders
- Provide new evidence-based interventions and assessments for individuals with eating disorders within the field of occupational therapy
- Provide evidence-based recommendations to enhance eating disorder program outcomes, such as implementing cooking groups and meal preparation as interventions in the outpatient setting, creating a community donation based closet to simulate shopping for clothes in the outpatient setting, implementing a shower protocol in the inpatient setting to reduce the risk of patient falls based on malnutrition levels, implementing an increase in one-to-one interventions, and expanding the sensory tool options for patients within the inpatient and outpatient settings based on findings from evidence-based research as well as my first-hand experience with patients.
Implementation of Trauma-Informed Care Through Education on the Polyvagal Theory
- Educational video created explaining the Polyvagal Theory and the basic inner-workings of the Autonomic Nervous System.
- Patient's participated in group therapy sessions learning, noticing, and exploring the effects of how the Autonomic Nervous System responds to trauma, adverse events or experiences, and every day events.
- Group therapy sessions prompted participants to explore their Autonomic Nervous System responses through various creative expressive mediums, such as writing, drawing, mindfulness-based exercises, gentle movement, and more.
Recommendations for Linden Oaks Behavioral Health and Potential for Growth
- Cooking Groups for the Outpatient Eating Disorder Program
- "Individuals with eating disorders struggle to eat in a normal, safe, and healthy manner without using over controlled eating or out of control eating to avoid or alter difficult emotions" (Lock & Pepin, 2017).
- Exposure challenges and therapy sessions for meal preparation and clean up
- Community Donation Clothes Shopping Closet for Outpatient Eating Disorder Program
- While shopping for clothes, clients can quickly become overwhelmed and too distracted by the clothing sizes and how they perceive the appearance of their bodies in the mirror.
- Exposure challenges and therapy sessions practicing clothes shopping
- Implementation of Shower Protocols for Inpatient Eating Disorder Program Based on Initial Assessment Metrics
- Risk of fall injury and fracture (Axelsson et al., 2022).
- Functional Reach Test (Rosa et al, 2019).
- Sit Up Squat Stand Test, Hand Grip Strength Test (Etemadi et al., 2021).
- BLACK: Seated the entire time with supervision
- ORANGE: Seated as needed with occasional standing using shower bars with supervision
- GREEN: Cleared for standing in shower with supervision
- One-to-One Interventions
- Following protocol for OTs treating patients with ARFID.
- Using this protocol to work towards implementing exposure therapy into treatment.
- Patient and Practitioner education is important (Waller et al., 2016; Wright & Waller, 2020)!
- Sensory Toolkit Expansion
- Cozy Canoe, Body Sock, Therapeutic Listening Tapes and Certification, Willbarger Therapeutic Brushing, Lean N Learn Wedge Cushion, Weighted Lap Pad
During my time working with children in the outpatient pediatric setting, I saw many children with an ADD/ADHD diagnosis. These kiddos had a lot of sensory needs in order to help keep their attention to the tasks we were doing and to help keep them regulated throughout session. The same can be seen for individuals with eating disorders who also have an attention deficit diagnosis. Through research that has been conducted and that is still continuing to be conducted, it has been found that “sensory processing disorders and eating disorder have a connection through picky eating, restrictive eating, and ARFID. These disorders include struggles with rigidity, sensory processing issues, negative associations with foods, and dysregulation of structure around mealtimes.”
Knowing patients with eating disorders have sensory needs as well as a dysregulated Autonomic Nervous System due to trauma, providing sensory based interventions and tools can help to further an individual’s progress in their recovery.
References:
Axelsson, K. F., Woessner, M. N., Litsne, H., Wheeler, M., Flehr, A., King, A. J., & Lorentzon, M. (2022). Eating disorders are associated with increased risk of fall injury and fracture in Swedish men and women. Osteoporosis International, 1-9.
Dumont, E., Jansen, A., Kroes, D., de Haan, E., & Mulkens, S. (2019). A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series. International Journal of Eating Disorders, 52(4), 447–458.
Etemadi, S., Sun, G. X., Leung, S. P., Siddique, A., Cooper, S., Ezenwa, N. C., ... & Robinson, P. (2021). The Sit Up Squat Stand test and Hand Grip Strength: What is the role of tests of muscle power in risk assessment in Anorexia Nervosa?. European Eating Disorders Review, 29(4), 670-679.
Frost, N. D., Laska, K. M., & Wampold, B. E. (2014). The Evidence for Present-Centered Therapy as a Treatment for Posttraumatic Stress Disorder. Journal of Traumatic Stress, 27(1), 1–8.
Giles, G. M. (1985). Anorexia nervosa and bulimia: An activity-oriented approach. The American Journal of Occupational Therapy, 39(8), 510-517.
Lock, L.C. & Pépin, G. (2017). Eating disorders. In Brown, C., Stoffel, V.C., Munoz, J. (2nd Ed.) Occupational Therapy in Mental Health: A Vision for Participation. F.A. Davis Company.
Rosa, M. V., Perracini, M. R., & Ricci, N. A. (2019). Usefulness, assessment and normative data of the Functional Reach Test in older adults: a systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 81, 149-170.
Vanzhula, I. A., Sala, M., Christian, C., Hunt, R. A., Keshishian, A. C., Wong, V. Z., Ernst, S., Spoor, S. P., & Levinson, C. A. (2020). Avoidance coping during mealtimes predicts higher eating disorder symptoms. International Journal of Eating Disorders, 53(4), 625–630. https://doi.org/10.1002/eat.23254
Waller, G., Walsh, K. D., & Wright, C. (2016). Impact of education on clinicians’ attitudes to exposure therapy for eating disorders. Behaviour Research and Therapy, 76, 76–80.
Wright, C., & Waller, G. (2020). The impact of teaching clinicians about implementing exposure therapy with patients with eating disorders: A nonrandomized controlled study. International Journal of Eating Disorders, 53(1), 107–112.
Zucker, N. L., LaVia, M. C., Craske, M. G., Foukal, M., Harris, A. A., Datta, N., Savereide, E., & Maslow, G. R. (2019). Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID. International Journal of Eating Disorders, 52(4), 466–472.