Eating Disorders Family Psychoeducation Part 2 Presented by: Seattle Children’s Hospital, Psychiatry and Behavioral Medicine Contributors: Cynthia Flynn, PhD Taryn Park, MD Angela Werfelmann Wood, MPS, LMHC, ATR Sarah Wu, PhD

What We’ll Be Talking About Today You and the eating disorder Tips for supporting recovery in the hospital Resources

You and ‘Ed’ You may feel like you and the eating disorder are the same. It may even feel like the eating disorder is helping you achieve your own goals… …but the way the eating disorder is going about it is making you ill. It will be helpful for you to separate your goals and values from the eating disorder. The goal of slides 3-7 are to introduce the concept of separating oneself from the eating disorder using the narrative CBT guide, “Life without Ed, by Jenni Schaefer. Providers need to bring a copy of Life Without Ed to provide to patients. If under 13, Life Without Ed should be given to parents to review before given to the child. If 13 or over, providers should use clinical judgement to determine if appropriate to give Life Without Ed to the patient without parental review first. (Book contains some content on divorce and navigating adult relationships.)

Separating from the Eating Disorder “The first step in breaking free from ‘Ed’ is learning how to distinguish between the eating disorder and yourself. You need to determine which thoughts come from the eating disorder and which ones belong to you. You will need to learn to disagree with and disobey ‘Ed’.” - Jenni Schaefer, “Life without Ed” After providing the Life without Ed book, providers should use this slide to give brief overview of content.

Separating from the Eating Disorder It is helpful to refer to the eating disorder as a separate entity in order to separate eating-disordered behaviors, thoughts, and values from yourself. Practicing separating from Ed is a strong and essential step in recovery. Providers should discuss strategies of separating self from eating disorder. Acknowledge and validate that this may feel awkward and/or difficult but that it is an important step in understanding the eating disorder and recovery.

Thinking like ‘Ed’ What ‘Ed’ said to Jenni: What Jenni learned to think and believe: When it comes to choosing food, I’m in charge. Of course. Beauty is in the number that appears on the scale. I can only be beautiful if I follow Ed. I make you special. Without Ed, I am nothing. If you can keep your weight low enough… … I can be in control forever. Providers should review and highlight that these are just examples from the book, and note that eating-disordered thinking can be different for each person. Ask patient if they can think of any personal examples of eating-disordered thinking. Adapted from Jenni Schaefer, “Life without Ed”

Learning to Separate from ‘Ed’ At first: Ed: You should not eat dinner Jenni: I know. I won’t eat dinner. During recovery this conversation changed to: Ed: You should not eat dinner. Jenni: You are wrong. I should eat dinner, but it’s really hard.   Then the conversation became: Jenni: You are wrong. I should eat dinner, and I will. The ultimate goal is to disagree with and disobey Ed. Review examples and then ask patient if they can think of any personal examples of when they have disagreed with their eating disorder. Adapted from Jenni Schaefer, “Life without Ed”

Supporting Recovery in the Hospital Don’t negotiate about food requirements Do try to provide meal support Don’t negotiate about exercise restrictions Do provide distracting conversation and low energy activity (e.g. art projects, watching movies) Don’t reassure fears about weight or appearance changes during recovery Validate that recovery can be difficult; redirect the conversation and coach coping skills Don’t give up Do try to model optimism and appreciate effort Don’t hesitate to ask for help Your team is here to support you Providers should highlight that these are tips for family members supporting recovery; encourage discussion.

Where to Find Additional Resources Organizations Academy for Eating Disorders, http://www.aedweb.org National Eating Disorders Association, https://www.nationaleatingdisorders.org Books “Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Method.” Janet Treasure, Grainne Smith and Anna Crane (2007) “Help Your Teenager Beat an Eating Disorder.” James Locke & Daniel le Grange (2004) “Off the C.U.F.F.” Nancy Zucker (2008), through Duke University Medical Center “Life without Ed: How One Woman Declared Independence from her Eating Disorder and How You Can Too.” Jenni Schaefer and Thom Rutledge (2004) “Getting to Calm: Cool-Headed Strategies for Parenting Tweens and Teens.” Laura Kastner and Jennifer Wyatt (2009) For more information, see our “Eating Disorders Booklist and Resources” www.seattlechildrens.org/pdf/PE456.pdf

Where to Find Additional Resources Classes and Groups Meal Support Class for caregivers at Seattle Children’s Hospital (for more information see our “Meal Support Class” handout, www.seattlechildrens.org/pdf/PE1371.pdf) Skills Training for Adolescents in Recovery (STAR) Group for patients at Seattle Children’s Hospital (for more information, see our “STAR Group” handout, www.seattlechildrens.org/pdf/PE1427.pdf ) Parent Skills and Survival Group for Eating Disorders at Evidence Based Treatment Center of Seattle. Group meets on Thursday mornings. There is a fee which may be reimbursable by insurance. Contact Jessica Jakubiak with any questions at  206-374-0109 or visit http://ebtseattle.com/ewdc.html for more information. With these last 2 slides, providers should give copies of the meal support class handout (if parents have not already attended), the STAR group handout (if clinically recommended) and the “Eating Disorders Booklist and Resources” (noting that there is some overlap and some additional resources on this handout).