Healing together: our therapeutic approach

Cognitive behavioral therapy for eating disorders (CBT-ED) is a generic term that encompasses all the evidence-based forms of CBT that have been developed for eating disorders, with a common core of encouraging nutritional and behavioral change as key to addressing the thoughts and emotions that underpin eating disorder and body image issues. CBT-ED also has had positive impacts on other comorbid issues, such as depression, anxiety, self-esteem, and quality of life. CBT focuses on the therapist and client working together towards common goals, individual decision-making, and corrective learning. Motivational strategies and cognitive interventions that emphasize collaboration and individual decision-making are often necessary to persuade clients to initiate difficult behavior change and improve nutrition, which are essential for developing the insight needed for further recovery. Therapists at Monte Nido work to maximize client autonomy, responsibility, and choice while supporting regulated eating, weight restoration and/or maintenance, and the reduction or elimination of compensatory behaviors. CBT interventions are utilized in all areas of care, from group work to individual therapeutic sessions.

We know that posttraumatic stress disorder (PTSD) frequently co-occurs with eating disorders. Therefore, it is imperative that trauma and trauma responses be appropriately addressed in intensive ED treatment. We offer Cognitive Processing Therapy (CPT), an evidence-based treatment for PTSD, at all levels of care. Most people who complete CPT show a noticeable improvement in PTSD symptoms. CPT typically takes 12 sessions, but this can vary from person to person.

Acceptance and commitment therapy (ACT) asserts that suffering is part of being human, and that suffering can be amplified as the result of efforts to make it go away. Acceptance and commitment therapy targets emotional avoidance and emotional control strategies through exploration of acceptance, observation of thoughts, ongoing awareness of self, and commitment to change that aligns with one’s values. Focus on these themes is essential to the work we do at Monte Nido, whether in our “Body & Soul Group”, our “Values Group”, or in our clients’ individual therapeutic assignments.

Motivation Interviewing (MI) is an approach for helping people to change their thinking and behavior. At Monte Nido MI is not used as a ‘stand-alone treatment’ but integrated into the framework of our overall treatment approach.The primary goal of MI is to resolve ambivalence and increase motivation to change through exploration of how one’s values and goals align with our current behaviors. It is important to not just connect to the “how” in recovery, but also the “why”.

At all levels of care, with clients of all ages, we believe that the engagement of family, caregivers, partners, and other primary social supports is essential to the effective treatment of eating disorders. We know that eating disorders are particularly good at isolating our clients from the people in their lives that give them meaning, motivation, and support. Universally referred to as ‘family work’, we do not consider this part of treatment to be optional. There are different ways to engage our client’s primary support systems and it’s important to be flexible in our definition of family and our expectations for those people. Monte Nido’s goal is to provide the necessary resources, education, and support for our clients and loved ones to successfully navigate recovery together.

Applied to eating disorders, exposure therapy is utilized to reduce or eliminate negative associations with food and/or weight gain. Additionally, it aids in building increased tolerance of difficult emotions. Creating new positive associations with team support at the table allows clients to experience food in powerfully healing ways.

Dialectical Behavioral Therapy (DBT) is based on biosocial theory, which explains how biological vulnerability together with the impact of one’s environment can result in emotion dysregulation, affecting psychological and social functioning. The aim of DBT is to help our clients understand and accept their difficult feelings, learn skills to manage them, and become able to make positive changes in their lives. ‘Dialectical’ means trying to understand how two things that seem opposite could both be true. For example, accepting oneself and changing your behavior might feel contradictory and DBT teaches that it's possible for people to achieve both of these goals together. Monte Nido integrates DBT into both our clients’ individual work and group therapy, teaching skills that clients can apply to their day-to-day life.

At every level of care, we are committed to Mindfulness-Enhanced treatment. Mindfulness is the practice of paying attention to the present moment, all while learning to let go of the judgment that we often carry about how things are. Our treatment approach draws upon practices and exercises that support present-centeredness, reduction of reactivity, and detaching from thought content. These approaches include behavior change strategies integrated with mindfulness skills or exercises but don’t require formal meditation. We view mindfulness as a way of being and relating to all of one’s experiences. Mindfulness interventions in the treatment of eating disorders guide clients through various practices of getting familiar with the environment (sound, sights, smells), the breath, emotions, and physical sensations as well as working through common barriers to mindfulness and self-compassion. Our mindfulness and compassion-based exercises and groups equip clients with tools for effective life-long emotional management.

Relational-cultural theory suggests that the primary source of suffering for most people is the experience of isolation. We know that eating disorders often result in isolation, impacting relationships with social supports, and allowing the eating disorder to take over. From a relational perspective, our experience of emotional distress is connected to inter-personal issues. Central to this approach is the idea that we are shaped by our social world and relationships, and that having good relationships is essential for our well-being and self-esteem. It is posited that people grow through and toward connection, and that their sense of meaning and well-being is anchored in relationships throughout the life span. We aim to reduce isolation through improved inter-personal communication, shared sense of community, and connection to necessary resources to build a strong foundation of support they can reach for post-discharge.