Eating disorders are deadly illnesses that must be addressed and comprehensively treated. We cannot waste time divided by deference to our pet philosophies when research has shown multiple modalities of treatment to have merit. It is imperative that we pool currently available resources to treat and eradicate these illnesses. Many of us, knowing this intuitively, have scraped together our own personal compilations of interventions from materials published in the academic literature, presented at conferences, and scattered among unpublished manuals. But there is tremendous value in curating this knowledge and assembling it in one thorough, integrated collection of evidence-based interventions for the treatment of eating disorders.
As coauthors of this work, we share that stance, and so we set out to explore how we could use different evidence-based interventions to help our patients recover from eating disorders. We began by distilling core concepts from a wide range of treatment approaches and then designed handouts that clearly explained this important information to patients and families. Over time, three of our integrated collections of interventions developed into individual, group, and family treatment modules. In this way, we conceived the treatment package that we call Integrative Modalities Therapy, or IMT (pronounced “eye-em-tee,” not “imt”). Wisdom from a variety of evidence-based treatments is incorporated into each of the three IMT modules, which are intended to be used on the basis of the individual patient’s needs. We like to think of IMT as offering practical options for those times in clinical practice when you just need something adaptable to address a patient’s presenting problems. IMT is a treatment package that was compiled, styled, and written by clinicians in the trenches for clinicians in the trenches. As such, this work reflects an approach to the treatment of eating disorders that is founded on evidence-based practice.
We quickly realized that an entire package of individual, group, and family interventions could seem a bit overwhelming, not just for clinicians in the trenches but also for patients struggling with eating disorders as well as for their distressed family members. And yet we knew that all the IMT material had to be experienced as simple. Therefore, our first and most important implementation-oriented goal became to present clinical information in a crystal-clear, approachable way. We used techniques from information design (the art of displaying information in an efficient and effective manner) and went to great lengths to make the IMT content easy to understand for patients, carers, and clinicians alike. When it comes to closing the treatment gap and standardizing care, we believe in the far-reaching potential of treatment material that can efficiently and effectively communicate important clinical concepts.
We began by designing the IMT handouts with patients’ needs in mind. Broadly speaking, IMT handouts are easy to read and are written in a developmentally appropriate manner for adolescents with such eating disorders as anorexia nervosa (AN), bulimia nervosa, binge eating disorder, and other specified feeding and eating disorder. Because of the way malnutrition can interfere with normal brain functioning, it can be particularly difficult for adolescents who have AN to process information, but similar cognitive impairments have also been shown to exist in patients with other eating disorders, such as bulimia nervosa (see Zakzanis, Campell, Polsinelli, 2010). Consequentially, adolescents with eating disorders can be overlooked in treatment because it is all too easy for clinicians to communicate only with the parents. The participation of family members in treatment is often necessary, but why wait until remission to work directly with the patient? Instead of seeing decreased cognitive functioning as an insurmountable obstacle, we should seek to overcome it. In IMT, we attempted in part to do this by creating handouts for patients with fun graphics and clearly displayed information. Further, we found ways to make mindfulness exercises more concrete, making it easier for an adolescent with any type of diagnosed eating disorder to focus. For example, patients record their internal experiences on organized handouts during mindfulness practice. As another example, during the classic “leaves on a stream” exercise, the therapist plays recorded nature sounds to help refocus the patient’s attention. In short, rather than bypassing the patient as a participant in treatment, the IMT material is specifically designed to meet adolescents with eating disorders where they are, both emotionally and cognitively.
Carers of patients with eating disorders are also in need of concrete information during treatment. When a child has severe eating disorder symptoms that require family-based therapy, many carers unexpectedly find themselves in the position of having to implement a life-saving treatment for their child at home, without much support. In addition, and unsurprisingly, carers are often very distressed and have difficulty retaining information from sessions. Therefore, it seems inefficient to rely on verbal communication alone to convey crucial treatment rules and concepts. To solve this problem, carers are given clear IMT handouts, often with enumerated lists, to guide them through treatment. Instead of being advised to read a whole book, carers, across multiple sessions, are given smaller amounts of relevant information that is presented in handout format and can be referenced and reviewed as necessary. Over time in treatment, as carers effectively contribute to the decrease in eating disorder symptoms—with the help of clear handouts describing how to execute behavioral interventions—carers build a sense of experiential mastery. In this way, interventions explained by clear IMT family handouts can aid carers in executing the tasks that their role requires.
In the interest of better serving the eating disorder population, we also designed the IMT material to anticipate the needs of clinicians. People with eating disorders and their impacted families exist everywhere, but few clinicians are willing and able to treat eating disorders. By making the intimidating treatment of eating disorders more approachable, IMT aims to attract clinicians who might otherwise shy away from treatment of eating disorders. You can think of IMT as evidence-based treatment in a box—a way to make it easier for clinicians to administer evidence-based interventions for a category of disorders that are difficult to treat. We hope that if we can help clinicians become more able to treat eating disorders, they may also become more willing to do so. In this way, we hope to contribute to the efforts of our friends and colleagues in the field to close the treatment gap.
We also hope to contribute to the efforts of our community by offering a set of interventions that are not only scalable and flexible but also relatively easy to implement for therapists who have a foundation in evidence-based treatments across the spectrum of clinical experience. We have found that the IMT handouts allow for a treatment to be both standardized and individualized. Because patients receive core conceptual information in a streamlined fashion, space is made in session for the patient’s individual needs. The eating disorder therapist who can draw on a comprehensive set of interventions is spared the effort of having to verbally reinvent the wheel by explaining each core concept to each new patient who begins treatment. In short, by decreasing the time that clinicians need to spend delivering core information, IMT saves time for care to be individualized. In addition, the IMT handouts a patient receives at one level of care can travel with that patient to a different level of care and be viewed by the new treatment team, and so the handouts can help, in a minor way, with continuity of care across treatment settings.
Our mission, in short, is to present this curated collection of evidence-based interventions for individuals, groups, and families in treatment for eating disorders as a way to help patients develop skills, support families, and provide a way for clinicians in the trenches to efficiently and effectively communicate core treatment concepts. And, given that we were already expending considerable effort to create this collection, it seemed to us that we could aim a bit higher, while we were at it, without too much additional effort. Therefore, our mission also includes closing the treatment gap with standardized, scalable, evidence-based treatments that can attract new clinicians who are willing to treat eating disorders and help standardize care in the field.
How You Can Help!
In the first five years of IMTs existence, we solicited feedback from users and incorporated every suggested change we could into the IMT material. Now that it has finally been published, we need help with dissemination efforts! If you would like to contribute, writing a review on Amazon is a great way to help. Further, if you have constructive feedback for us, please feel free to contact us directly using the Contact page on this website. We will do our absolute best to accommodate your feedback into future editions of the manual.