Eating disorders are dangerous, life-threatening conditions that affect all aspects of the individual. In the past, many treatment models focused solely on the psychological, medical and nutritional components of the eating disorder itself rather than treating the complete, individual person. Now there is a model that builds off the traditional methods to focus on healing all dimensions of the whole person. To do this, clinicians must understand the biological underpinnings that cause eating disorders and the behaviors that help maintain them long-term, and work together in multi-disciplinary teams to achieve total health.
The Adaptive Care Model
The Adaptive Care Model was developed by a group of industry experts at Alsana, an eating disorder recovery community, working together to create a comprehensive, integrated model for eating disorder treatment centered on total health for each client. This model is built on the belief that full recovery is possible when an individual is approached collaboratively with compassion, and has the opportunity to receive evidence-based treatment. The model treats the whole person, addressing five dimensions through an integrated approach:
- Therapeutic: The therapy program is centered on an understanding of the complexity of eating disorders and their underlying biological, behavioral and environmental influences. Therapy is provided with compassion and acceptance to create an environment in which clients stabilize symptoms, process underlying issues, and integrate changes to create a life worth living based on values and a sense of purpose.
- Nutritional: The nutrition program integrates the balance of nourishment and pleasure within a real-world environment to restore a nurturing relationship with both food and body. This dimension is focused on helping clients learn to experience food, meals, cooking and even shopping with joy.
- Medical: The medical program is based on building health resilience to provide a physical foundation of recovery. Clinicians treat the nuanced medical, physical, and psychiatric complications of eating disorders with a comprehensive plan, consistent methods, precise interventions and compassion.
- Movement: The movement program is built on evidence-based treatment that integrates progressive levels of movement as healing for both body and mind. Clients learn how to enjoy and relish everyday activity and exercise in a healthy way.
- Relational: The relational program provides guidance and support for clients to explore and grow their own sense of purpose as part of the recovery process. Individuals recover in relationship with others, themselves and in connection with a deep sense of purpose.
Data-driven and innovative treatment methods support recovery by targeting areas of the brain specifically affected by eating disorders. When combined with ongoing assessments and feedback from the client, interventions are tailored to meet the specific needs of the individual. The Adaptive Care Model is not based on a specific method or intervention style, but rather encompasses all the appropriate methods available, and determines how best to apply them to each client based on his/her unique situation, assessments, feedback and personality. At the heart of the Adaptive Care Model is compassion and understanding. By viewing the individual as a person and treating all dimensions of that person, the model is better able to adapt to each client’s needs to achieve total health.
Treating the Root Cause of Eating Disorders
The Adaptive Care Model builds off of a neurodevelopment model of etiology for the eating disorder, and addresses the eating disorder in its development and maintenance phases. Eating disorders develop in individuals with a biological diathesis that is triggered by a behavioral activator – typically dieting behavior. This biological diathesis is the result of a genetic predisposition and interpersonal neurobiological development within the individual. Eating disorder symptoms are then maintained based on the emotional, relational and neurological adaptive function they have taken on.
The Adaptive Care Model takes into account the biology, genetic predisposition and neurochemistry that result from early attachment patterns. It leverages the interpersonal neurobiological model that describes human development and functioning as a product of the interaction between the body, mind and relationship, understanding how the brain and mind are developed and how they function based on the interplay of genes in the context of relationships.
The model recognizes the predisposing, precipitating and perpetuating factors that contribute to the disorder’s development and maintenance over time, allowing clinicians to target interventions to specifically address these factors:
The heritability of eating disorders is estimated to be as high as 70 percent, while children of individuals with eating disorders are up to 11.3 times more likely to develop one themselves than the general population. Common temperamental factors associated with eating disorders include harm avoidance, novelty-seeking, perfectionism and persistence, while specific neurochemical and neurobiological findings have also been identified including problems in reward system, decision-making, perseveration, interoception and perception of body size.
In terms of precipitating factors, dieting has been identified as potent predictor in the development of eating disorders. Relatedly, the vast majority of individuals with eating disorders reported that dieting attempts preceded the onset of their disorder, suggesting that dieting may represent a common developmental path to both disorders.
Once the eating disorder has been triggered, perpetuating factors — emotional, relational, neurological and chemical – take hold to maintain the disorder. The maintenance of the eating disorder is usually a protective strategy, yet these perpetuating factors have different and multiple functions, often evolving over time to explain what the individual gets out of the eating disorder and why he/she continues to engage in the behaviors. For example, the eating disorder may start as a coping mechanism for emotion dysregulation and eventually transforms into an obsessive compulsive disorder ritual or a relief from depression. Other perpetuating factors include:
|Inability to express distress||Substitute for relationship/intimacy|
|Fear of responsibility||Manifestation of unfinished business|
|Control or out of control privately||A need to care for someone and escape|
|Substitute for love or affection||Keeping away from others|
Neurodevelopment Model Applications
The Adaptive Care Model places significant importance on educating clients and families on the neurobiology of eating disorders to help remove shame and provide a deeper understanding and appreciation for the complexity of the condition. Brain-based interventions and attachment-based interventions are then applied to prime each client’s brain for change. Using relationships as vehicles for change, methods include:
- Stabilization interventions, including cognitive behavioral therapies, to eliminate behavioral precipitating factors such as dieting
- Processing interventions, such as Eye-Movement Desensitization Reprocessing (EMDR), Somatic Experiencing (SE), and Expressive Therapies, to create neural integration
- Integration interventions, such as Acceptance and Commitment Therapy (ACT) and spiritual/relational therapies, to create an application of strategies for a life without an eating disorder
The Adaptive Care Model integrates evidence-based practices to prepare the brain to change its behaviors, enabling the individual to accept changes to eating disorder behaviors faster and more effectively.
Cognitive remediation therapy and self-directed neuroplasticity are used to improve brain flexibility and cognitive speed and processing. Brain changes with neutral stimuli are practiced first so muscles are ready when individuals work to change their eating disorder behaviors. Examples of these exercises include crosswords, timed tasks, word-find puzzles and spatial reasoning tasks.
By addressing the etiological, underlying causes and maintaining aspects of eating disorders, clients can progress in all five dimensions of care throughout their recovery journey, and prepare to transition back to the demands of everyday life while learning how to live healthy, happy and meaningful lives.
Adaptive, Collaborative, Compassionate
The Adaptive Care Model places each individual client at the center of the model and with all efforts adapted to meet their needs through collaboration and compassion.
Rather than establishing a specific style or method of treatment, the Adaptive Care Model embraces all evidence-based methods and uses data from ongoing assessments and client feedback to inform treatment plans and identify opportunities for adjustments as needed.
Through ongoing assessments, emotional regulation, cognitive abilities, self-compassion, mindfulness and neural flexibility can be measured, helping to monitor neural integration associated with the recovery process and confirm that applied methods address all predisposing, precipitating and perpetuating factors.
To ensure all methods are available to clients, treatment teams must be trained in a wide variety of treatment practices and be nimble enough to recognize when something is working and when it isn’t to shift gears when needed. Staff must become experts in these methods so they can adapt their strategies based on each client’s needs and neurobiology. The Adaptive Care Model is best served in a supportive work environment where staff are trained, supervised and supported so they can provide the highest-quality of customized care to each client.
Implementing a multi-disciplined approach to treatment that integrates five distinct dimensions of an individual’s wellbeing requires teamwork and communication. To guarantee consistency of care, all teams must constantly be in synch, collaborating on treatment plans and dynamic interventions that address the unique needs of each client.
Adaptive Care Model treatment plans are designed to include all five dimensions of care on a daily basis. For example, clients may start each day with mindful activities such as stretching and yoga, as well as eat their meals with gratitude and intention. These seemingly normal tasks address the psychological, medical, nutritional, relational and movement components with overlapping methods, similar to real-life circumstances.
Through regular assessments and team meetings, providers can track individual client progress across all five dimensions and make adjustments as needed to ensure sustainable recovery. In addition, clients meet with the team every week to provide his/her feedback directly to care team members and get updates on progress to ensure everyone is involved in the process from start to finish. Assessments begin upon admission and continue throughout treatment and discharge. In addition, treatment teams follow-up with the client one year into recovery to provide a source of ongoing support.
In addition, the Adaptive Care Model approaches treatment with compassion and understanding. Eating disorder recovery is a difficult journey, with mental, physical and spiritual challenges along the way. To help clients develop trust, it is important to create a nurturing environment where clients feels safe to try new things and take risks. This model encourages clinicians to demonstrate their own vulnerability and authenticity so clients know the evidence-based practices are built on a foundation of compassion and caring.
The strength of the therapeutic alliance is vital to the success of the Adaptive Care Model. Regardless of which methods are used, good outcomes depend on the relationship between each client and their providers. This relationship is key, as we know that relationships impact neurochemistry to facilitate the change process. . Measuring the strength of each client’s therapeutic alliance on a weekly basis helps gauge the ups and downs of recovery so adjustments to interventions can be made to improve the quality of the relationship.
The Adaptive Care Model is designed to bring together treatment methods from five different disciplines to form a comprehensive, cohesive approach to caring for the whole person. Providers must understand the difficulty of eating disorder recovery and value each of the five dimensions of care as part of achieving total health in the individual. Through data collection, understanding and compassion, the methods can be properly applied, tailored and implemented for a collaborative approach between teams and with clients.