Acceptance Commitment Therapy in Eating Disorders

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By: Melissa Gerson, LCSW

Imagine this: You walk into a social gathering to find yourself among a group of people you don’t know. Immediately thoughts begin flowing into your mind: “I don’t know anyone here!” “Who should I talk to?” “If I am standing here talking to nobody, people will think I am a loser” “What if I go up to someone and they don’t want to speak with me.” “I look so awkward right now” “This shouldn’t be so hard for me.” The next thing you experience is the your heart pounding so loud you are convinced others can hear it, beads of sweat dripping down your forehead and an extreme desire to flee the situation.

In this scenario, the attachment to these thoughts and worries led to an emotion we may know all too well: anxiety. In our work with eating disorders, we find that anxiety is often a trigger for destructive food behaviors: restriction, binging, purging or some combination.

From the perspective of ACT, also known as Acceptance and Commitment Therapy, the intensity of anxiety experienced in this aforementioned scenario arises from a process known as cognitive fusion.

Cognitive fusion is a central concept in ACT, which is an empirically based psychotherapy developed by Stephen C. Hayes . Cognitive fusion is a process, in which we are bound to and inseparable from our thoughts. You can say that we are welded or bonded to them so strongly that we begin to see them as more than just thoughts, and rather as absolute truths or facts.

Rather than noticing or observing, “I look so awkward right now” as a thought, in a state of fusion, we experience it as a fact about reality: “I look so awkward right now and therefore I am so awkward right now.” We become stuck to these thoughts, which fuels their power over our behavior. In other words, these thoughts may motivate us to avoid engagement in conversation with others, leave a social gathering or perhaps engage in maladaptive behaviors to reduce the unwanted negative emotion that ensues, all of which causes us to lose contact with reality and our experience with the present moment. Rather than creating contact with the world of direct experience, we become lost in the world of language.

So how can we recognize when we are in a state of fusion? According to ACT, we can watch out for fusion in 6 areas:

1. Rules

Are there any implicit rules that you find you hold for yourself about work, relationships or about life in general? Do you ever notice yourself saying words like should, can’t, must, have to, ought?

2. Reasons

Do you find yourself generating rationales about why change is unattainable for you specifically? Fusion to these thoughts can get in the way of creating movement necessary for recovery. It reduces self-efficacy and prevents us from making the change we are capable of making.

3. Judgments

Although judging in certain circumstances can be important and even useful, many judgments can be unhelpful and harmful. Fusion to judgments about ourselves and others including, “I am ugly” or “I am an addict” can be detrimental and preclude us from developing meaningful lives. These judgments of evaluation enhance our suffering by disconnecting us from facts about ourselves and the world around us.

4. Past

Although the past has already happened, you may find yourself stuck to certain moments in your past. Fusion to these thoughts detaches us from the present moment and the world of direct experience. We may lose touch with things right in front of our eyes that may bring us joy and pleasure.

5. Future

Although the future has not happened yet, do you find yourself worrying about things that might happen? Fusion to thoughts about the future pulls us away from being effective in the present moment and may exacerbate high levels of anxiety.

6. Self

Are you attaching to a certain description of yourself? These can include thoughts like “I am depressed” or “I am sick.” Sticking to these thoughts make them rigid and inflexible and therefore, can prevent us from becoming the people we want to be living the lives we want to live.

The good news is ACT has a solution. From the ACT perspective, the way to reduce psychological suffering is to change our relationship to distressing thoughts. This can be achieved through a process called Defusion. Through defusion, we learn to create distance between ourselves and our thoughts, which help us see them for what they are: words, images and pictures. This is not to say that these distressing thoughts will not enter our mind, rather defusion teaches us that when they do, they do not have to dictate our behavior. Through this separation, we can begin observing thoughts as statements that may or may not be true and that can enter as well as exit our minds.

Harris, R. (2009). ACT made simple. Oakland, CA: New Harbinger Publications, Inc.

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.

You Don’t REALLY Believe That?

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By: Erin Parks, PhD

Having appreciated the humor that comedians have poked at“awareness” campaigns, I wanted to be very intentional about what, exactly, I wanted to make people aware of during Eating Disorder Awareness Week (#EDAW). And then the answer hit me in the face.  I was interviewing a clinician—she was kind, funny, had an excellent resume—and I was telling her about the culture and theoretical orientation of our center.  I told her that our research uses neuroimaging and genetics to look at the neurobiological underpinnings of eating disorders and that our three clinics take an agnostic approach, consistent with Family Based/Maudsley therapy, in that we truly believe that parents do not cause eating disorders and they are not to be blamed.  The applicant smiled, met my gaze, raised her eyebrows, and leaned in as though we were about to share a secret…

“I understand why you tell the parents that, but surely you don’t really believe that.”

really do believe that parents do NOT cause eating disorders.  I share that belief with our directors, our researchers, our clinicians, our office managers, our dietitians, our cooks, and every last member of our staff.  We believe, that like cancer and epilepsy and schizophrenia and autism, there are neurobiological and genetic causes to eating disorders.  But it is easy for US to believe this—we spend our days working with wonderful parents. These parents remind us of ourselves; they’ve been trying their very best to raise happy and caring children. These parents are shocked that their child has become so ill, because similar to the interviewing clinician, they too had previously believed that poor parenting caused eating disorders.

I wish I could say that was the first time in an interview that someone had asked me if I secretly blamed the parents, but there are many intelligent and caring people—clinicians, teachers, neighbors, friends—who believe the common myth that parents cause eating disorders.  This myth of parental causation has existed for many illnesses and most mental health disorders: schizophrenia, ADHD, autism, depression.  But it feels particularly pervasive for eating disorders—why is that?

Eating disorders have the highest mortality of any mental illness—rates that many studies suggest may be comparable to common pediatric cancers.  And yet, when we hear of a child getting diagnosed with cancer, friends and neighbors spend very little time wondering what caused the cancer and instead energy is focused on treating the cancer and supporting the family. The same is not true when a child is diagnosed with an eating disorder. When I asked a group of caring, intelligent parents what thoughts came into their minds when hearing of a 13-year-old being hospitalized for an eating disorder, they confided that they wondered about the parents: did they diet in front of their children, did they pressure them to succeed, what messages did they give about body image? There is this cultural sense that there is a right way and a wrong way to raise a child, and doing it incorrectly can cause problems—including eating disorders.  So what is the right way?

There is a prolific stream of (conflicting) parenting articles offering the latest opinion/theory/research on how to approach feeding your family.

Don’t feed your kids sugar: they’ll become addicted.  Feed your kids sugar: depriving them will make them binge later.  Make your kids try new foods: if not, they’ll never develop a healthy pallet.  Don’t worry if your kids are picky eaters: they will have disordered eating if you make food a battle.  Don’t bribe your kids with food: food shouldn’t be a reward. You can bribe your kids with food if it helps them eat their vegetables.  Hide vegetables in your kids’ foods. Don’t lie to your kids about what’s in their food.  Let your kids eat as much or as little as they want: follow their lead so they become intuitive eaters.  Your kids should be on a schedule, including meals: structure is good for kids. Gluten is bad.  All food is good.  Kids have to eat meat.  No kids should eat meat.  Dieting is bad: teach kids to love their bodies at all shapes.  Model healthy eating: we have an obesity epidemic.  If you put your kid on a diet they will develop an eating disorder.  If you don’t put your kid on a diet they will become obese and get diabetes.  Confused yet?

The conflicting advice continues when the parenting articles discuss achievement.  Parents should teach their children art and music and sports and STEM skills and foreign languages.  Parents enroll their children in way too many activities.  Parents should let their children choose their activities. Tiger Moms vs Free Range Kids. Kumon vs Montesorri.  It’s your fault if your children get hurt—you should have been watching them.  Don’t be a helicopter parent and let your children play unsupervised.  Challenge your kids, they need frustration and failure—they need grit.  Don’t push your kids—they’ll develop eating disorders.

Parenting is an unyielding stream of decisions, creating infinite iterations of parenting.

Our clinic has worked with hundreds of families and while their home cultures slightly differ, most are just typical families, trying to find moderation amid the sea of conflicting internet advice when it comes to feeding and raising their kids.  No matter what food and parenting choices they made for their families, somewhere there is an expert saying that they made the wrong choice and that is why their child has disordered eating.

A confession: I have two toddlers and I consume the endless stream of conflicting parenting articles that fill my Facebook feed and the Huffington Post. Sometimes I WANT parents to be the cause of language delays and college dropouts and cancer and bullying and ADHD and eating disorders. Then I could just parent correctly and guarantee that nothing bad will ever happen to the two children I love most in this world.  But that is not our reality.  In reality there are pros and cons to all decisions and there are complex causes to complex issues.  The reality is that parents everywhere are trying their very best, doing a very good job, and are parenting in ways that may look very similar to how each of us parent—and their children are struggling with difficult and scary things—including eating disorders.

Many articles this week will talk about hypothesized causes of eating disorders—food culture, focus on achievement, the media—and while it can be important to think about the negative consequences of some aspects of our culture, this search for a singular cause can feed into the culture of blaming the parents.  The majority of parents will diet, the majority of women will feel bad about their bodies, the majority of teens will feel pressure to succeed, and the majority of images of women in the media will be distorted and unhealthy—and yet the majority of children will NOT get eating disorders.

I hope we can turn the conversation to the successful evidence-based treatments that now exist for eating disorders and how we can improve upon them so that they are effective, accessible, and affordable for everyone.  I hope we can discuss how parents know their children best and can be the most wonderful treatment allies in helping their children fully recover from an eating disorder.  I hope everyone can now believe that parents are truly, really, not to blame.

This post originally appeared on

About the Author: Dr. Erin Parks is a clinical psychologist and the Director of Outreach and Admissions for the UC San Diego Eating Disorders Center for Treatment & Research . She is passionate about educating clinicians, parents, and the community about the neurobiological basis of eating disorders and the evidence-based treatments that are now available. Dr. Parks wants to help society view mental illness as brain illness–narrowing the funding and resource gap between physical and mental disorders.

Crafting an Empowering Therapeutic Journey

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By: Dr. Whitney Robenolt

One of the hardest parts of beginning your treatment journey is seeking out therapeutic support. The therapeutic process is typically associated with a state of vulnerability that at times can promote apprehensive thoughts, especially for those seeking support for the first time.

As an outpatient psychotherapist I find it important to advocate for individual treatment, in order to promote the notion that you can be an active and empowering member of your therapeutic journey. Finding the right therapeutic match may not always occur the first time you step into a therapist’s office. However, it is important to be hopeful; you will find your right match! Conduct research. Search for specialized treatment providers in your area. Seek out support groups in your area, asking others their recommendations for powerful therapists. Contact local therapists of interest requesting a consultation to discuss the potential treatment process, including their knowledge of eating disorder etiology and treatment modalities.

Mental health symptomatology and presentation, especially within eating disorders, is not always black and white. Those who present with disordered eating patterns do not always fit into a specific mold. Eating disorders are not biased, and it is important that your future therapist will provide effective support and treatment for your individualized needs. Ask questions. Many of the individuals I see for psychotherapy are often hesitant to initially ask questions. I believe questions are an integral part of the therapeutic process. It allows you to become an active member within your own treatment journey. There have been many studies that have focused on the importance of the therapeutic relationship and ability to give feedback to your therapist. Contrary to some beliefs, therapists cannot read minds. If you have questions regarding aspects of treatment, are unsure if your needs are being met, etc., these are all perfect topics to discuss with your therapist in order to create the most effective treatment. Creating a safe therapeutic space for open and honest communication is often of primary importance to many therapists.

We are all people who at times may feel flawed, but it is important to remember we all are of value! We all can be our own warriors, promote change, and empower others and ourselves. A strong and effective therapeutic journey will assist in allowing you to see you own value. However, it is important to remember that the first step comes down to you, to pull from your internal strength and motivation, to know you are worthy of rediscovering your value.

About the Author: Dr. Whitney Robenolt is a doctoral-level, outpatient, psychotherapist, practicing in Danville, PA.  She currently works as a member of private practice, John G. Kuna, Psy.D. & Associates. She has worked with a wide variety of diverse individuals, including those working towards eating disorder recovery.  She believes the psychotheraputic process is a valuable tool to instill hope, understand one’s value, and making life changes to improve quality of life. She has conducted research on eating disorder etiology and has been a presenter at the Pennsylvania Psychology Association Annual Convention regarding eating disorder treatment modalities. 

About Bulimia

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By: Melissa Gerson, LCSW

Alex starts her day with the intention to “be good.” As she navigates through her day, burdened by negative body thoughts, she feels down but hopeful that she will eat “clean” and with control. By mid-afternoon she’s starving and preoccupied with thoughts about food. When a co-worker puts out a tray of desserts for everyone to partake, Alex tries to resist but then can’t get the treats out of her mind. So she has one. Then another.   She’s on autopilot, out-of-body.   After too many cookies to count she’s despondent, miserable, stuffed.   She purges in the office bathroom since the full feeling is intolerable… and of course, the threat of absorbing all the calories is equally terrifying. Alex is resolved to make this her last binge/purge.   She’s “back on track.” But before you know, a food “mistake” or unexpected temptation gets in the way and the rest is history.

The pattern I just described is the classic bulimic cycle. There is restriction, deprivation, rules about what is on or off limits… Then a temptation, giving in, a food “mistake…” The binge means freedom from the exhausting control – at least for a short while. But then remorse, self-hatred. The purge is supposed to “undo” the binge but at the same time, without realizing it, the purge forgives the binge, actually opening the door for more binges in the future.

Most individuals with bulimia, will relate to some element – if not every element – of this cycle.*   The problem is that intuitively, it seems like more control and restraint are needed. The reality is that the exact opposite is true: over-control, deprivation, rigid rules are to blame. Because of this misguided effort to increase control, many who struggle with bulimia try and try again to end the cyclical pattern but find themselves frustrated in the process – and left with more shame, self-loathing, isolation.

What you should know about bulimia:

  1. Frequent purging – either by self-induced vomiting or laxatives – can lead to dangerous medical complications. The most common concern relates to cardiac health since minerals essential for proper cardiac function like sodium, magnesium, phosphorous get depleted through fluid loss. The only way to know if you have imbalance of these minerals is through a blood test. Your health status can change quickly so frequent labs are essential if purging is happening regularly. You could absolutely be at risk for a serious cardiac event but physically, feel no indication that anything is wrong.
  2. It is so important to consider a behavioral therapy like CBT-E, a treatment designed – and proven – to treat bulimia nervosa. CBT-E is so successful because of its laser focus on the factors that are keeping the cycle going – things like chronic dieting or restriction, rigid food rules (i.e. good and bad foods)… and also factors like intense focus on weight/shape, harsh comparisons to others and body checking like frequent weighing or body checking (mirror, pinching etc).
  3. CBT-E focuses on guiding you to a pattern of regular, consistent and flexible eating – an eating style that tends to reduce one’s vulnerability to binge eating and purging.   The treatment works to change your relationship with food (and thus your control!) by integrating:
    1. Flexibility: encouraging an approach to eating that allows for last minute changes, social eating, managing with the food available to you.
    2. Variety: balanced, satisfying meals. Moving away from having “off limit” foods since those tend to be the very things people consume in excess later.
    3. Adequacy: under-eating, delaying eating for long periods makes you more vulnerable to over-eating. If you’re starving, it’s harder to stay in control.
    4. Awareness: being present, aware of what is happening in the moment is key to maintaining control over eating behavior.
    5. Planning: you mustn’t under-estimate the power of being prepared. For many who struggle with BN, decisions on the fly lead to trouble. We want to move away from impulsive decision-making.
  4. Treatment must also address your current coping strategies since binge eating and purging for many are actually methods for relieving stress, numbing out, escaping….   To recover, you will likely need to establish alternative methods of coping – skills and strategies so you can care for yourself and manage feelings without defaulting to food-related behaviors.

Bulimia: The Bottom Line

There are many factors that contribute to the development of bulimia – biological/genetic, cultural/social, emotional…. But often what caused the problem in the first place is less important to focus on that the factors that are keeping the problem going now.

Bulimia is highly treatable. With the right intervention, people are able to make significant changes very early on in treatment. It is so important to seek help if you’re stuck in a destructive cycle with your eating.

* Please note that every individual is different. The pattern described in this post is among the more common presentations but there are many who have a very different “clinical picture.” Regardless, it’s essential to understand your pattern so that you can target the factors that are keeping it going.

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.

What’s An Eating Disorder IOP?

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By: Melissa Gerson, LCSW

An Intensive Outpatient Program (IOP) is a treatment option that serves as a step-down from a residential or partial hospitalization program, or a step-up from standard outpatient therapy. IOP is an opportunity for individuals to engage in their daily lives (i.e. participate in work, school or community and social activities) while working toward treatment goals in a supportive and structured environment. For those who are phasing back into their everyday lives after a residential stay or partial hospitalization program, IOP is an opportunity to restore independence. For those who are seeking a higher level of care than a traditional outpatient program, IOP provides more points of contact with a treatment team and peers while enabling participants to participate in the activities of daily life, as appropriate.

What is the time commitment for an Intensive Outpatient Program?

Traditional IOP programs will require between 6-15 hours of treatment per week over the course of 3-5 days. The intensity (i.e. 3 vs 5 days) depends on the individual needs of the client.  Some programs run IOP in the evening hours (5-8pm or 6-9pm) while other programs may offer more flexibility with daytime options for those whose schedules allow.

What does treatment look like on a day to day basis?

IOP is an opportunity for many to “jump start” treatment. In other words, in a short amount of time, programs work to redirect and shape behaviors, change long-standing patterns and support new strategies for stable eating. Typical expectations for an IOP suggest a 50% reduction in symptoms within 8 weeks.  For those who are stepping down from more intensive settings, IOP may be structured differently…. to slowly expose the individual to more and more independence until the client feels confident to move on.

IOP hours typically include group therapy, supported meals, individual therapy and family work (if indicated).  Intervention strategies and objectives vary by disorder. For example, for AN clients, it’s important to see movement toward more varied and balanced eating along with a clear trajectory of weight restoration. With bulimia, an ideal program will focus in on food exposure, variety and skills for managing/coping with urges to binge or purge. For binge eating disorder,  an IOP program would be geared around skill building, developing self-awareness, mindfulness, distress tolerance, and emotion regulation.

To determine if an individual is appropriate for an IOP program, clinics will typically utilize standards established by the American Psychiatric Association.  Below is a basic chart – based on the APA standards – that we use at our Columbus Park IOP.  It represents some factors we consider when establishing the appropriate level of care for individuals coming into our program.

Standard Outpatient CriteriaIntensive Outpatient Program  CriteriaPartial Hospital/Residential/Inpatient Criteria
Medically stable/cleared by Medical DoctorMedically stable/cleared by MD/ frequent follow up requiredMedical instability
With guidance, pt is capable of creating one’s own meal structureExternal structure needed to eat or gain weightSupervision required during/after meals
Fair to good motivation to recoverAt least fair motivation to recoverPoor motivation to recover
Co-morbidities  (i.e. depression, anxiety) may have some limited impact on functioningCo-morbidities (i.e. depression, anxiety) have high impact on functioningPsychiatric condition requiring hospitalization
Suicidality, if present, is passive (no active plan or intent to take one’s life) 

Suicidality, if present, is active and more structure/points of contact needed.  Possible suicide attempts in past.


Suicidality is active w/intent and plan and unable to contract for safety
Some ability to control exerciseSome ability to modulate exerciseStructure needed to prevent compulsive exercise
Some social supportLimited social supportNo support available to add structure outside of treatment


Could you or a loved one benefit from an IOP program? Most insurance carriers list local facilities that are covered in their networks.  You can either look on your carrier website or call a representative who can walk you through the covered facilities.  It’s also great to search online since most programs will have detailed information on their websites.  You’ll want to get a sense of the overall program philosophy, treatments used, structure and schedule.  Ask for a tour or informational meeting to get more of a sense of the setting.   Be an educated consumer and ask questions.  You have a right to know what you’re getting into even before you go in for an initial assessment.

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.

So What is CBT-E?

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By: Melissa Gerson, LCSW

Consistently across research trials, Enhanced Cognitive Behavioral Therapy (CBT-E) is shown to be the most effective treatment for eating disorders in adults. CBT-E is without a doubt the leading intervention for most individuals with Bulimia Nervosa and Binge Eating Disorder.   For adult Anorexia – a more difficult condition to treat once the behaviors have habituated – CBT-E is also shown to be a first line treatment and effective in the majority of cases.

CBT-E is a short-term, time limited, individual outpatient therapy. Patients work one-on-one with their CBT therapist to uncover the factors that keep their eating problem going – and then systematically they together, tackle them in the treatment.

For Bulimia and Binge Eating Disorder, CBT-E treatment consists of 20 treatment sessions over 20 weeks.   For people who are underweight, the treatment tends to be longer (typically 40-sessions over 40 weeks for Anorexia).

CBT-E has four stages. In Stage One, the focus is on fully understanding the factors contributing to and maintaining the individual’s eating struggle. Early on, the therapist works with the client to encourage regular, consistent eating (yes, it’s possible). There is a focus on increasing self-awareness and using problem solving techniques to understand why at times eating goes off track. In this first stage of treatment, it is best to meet twice-weekly. A lot of change should occur during this initial stage of treatment (the first 4 to 8 weeks).

In the brief second stage, the therapist and client review progress together and construct a plan for Stage Three.

Stage Three involves weekly sessions focused on the factors that may be continuing to keep certain eating struggles going. Typically, any intense concern with weight and shape will be addressed thoroughly in this stage of treatment. Dieting and other forms of over-control of food are considered important areas of focus here as well. The therapist will also work with the client to better manage event and mood triggers for disordered eating.

Towards the end of Stage Three and in Stage Four the session shifts attention to the future; specifically, on how to reduce vulnerability to setbacks or relapse in the months and years ahead.

They say that CBT-E should “fit like a glove.” So while it is a manualized and highly structured treatment with very specific strategies and protocols, it is designed to shape itself to each individual’s needs. The attention is always on the client’s unique picture…. on understanding the ins and outs of the individual’s patterns and triggers.

If you are interested in CBT-E, be sure that you seek out providers who practice CBT-E true to its design. Using CBT-E strategies here and then without full fidelity to the model will weaken the treatment. Once you find a provider who practices CBT-E, you can arrange an assessment to see if it is the right treatment for you.

About the Author: Melissa Gerson, LCSW is the Founder and Clinical Director of Columbus Park, Manhattan’s leading outpatient center for the treatment of eating disorders. As a comprehensive outpatient resource for individuals of all ages, they offer individual therapy, targeted groups, daily supported meals and an Intensive Outpatient Program (IOP). Columbus Park uses the most effective, evidence-based treatments like Enhanced CBT and Dialectical Behavior Therapy (DBT) to treat binge eating, emotional eating, bulimia, anorexia and other food or weight-related struggles. They track patient outcomes closely so they can speak concretely about their success in guiding our patients to recovery.

Right Time, Right Place, Right Therapist

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By: Frances Coleman-Williams

Having suffered from anorexia for over half my life, I had come to the conclusion life wasn’t worth fighting for. My belief that I was fundamentally flawed was confirmed every time I failed to get better. Restricting food and purging even the tiniest amounts sapped all my energy and I couldn’t think straight. I was exhausted, slowly killing myself and I didn’t care. The voice in my head was getting her way. She told me not to eat and told me she cared for me and wanted what was best for me. I believed her for many years. I’d failed at therapy after therapy and I couldn’t see even a chink of light in the darkness. No one seemed to understand me, they claimed they did but why then did they make ridiculous comments and talk so patronisingly to me?! I know I need to eat more but I CAN’T. I know I need to stop exercising but I CAN’T. I do not need educating, I need understanding.

I was dragging my sorry body down the road during one of the numerous walks I made myself do when I received a phone call from the dreaded Day Care offering me an appointment for an assessment. My heart was beating so hard I thought I was going to faint. I held it together and agreed to go in. The voice inside my head told me this was futile, ridiculous and that they would just make me fat. But something else within my shouted out that I could no longer live like this and something had to change, I needed help and this was worth a go. Of course, I feared I’d be turned away for being too well as I was convinced I was too fat to need intense support but they advised me to join the day program immediately. Again, the voice told me I should run away, they would make me fat and they’d not care for me as much as she did. Although lacking in energy and spirit, I was determined to make this time work. I decided I wasn’t going to throw this opportunity away. I decided I’d be completely honest and put a stop to my living hell once and for all. While at Day Care I was referred to a new therapist. I was skeptical to start with, I didn’t think he’d see me because he was a family therapist and usually saw sufferers with family members. But he saw me on my own. For the first time he was not doing therapy to me – previously experiences were of someone trying to do DBT, CBT etc to me, as though I was an illness that needed irradiating. For the first time he was open to who I was not what I was. For the first time I was with someone who would let me cry, scream or be silent and he wouldn’t judge me, try to stop me or talk about a finite number of sessions in which we had to ‘complete’ therapy. I saw this therapist for a few years, initially weekly, eventually monthly and I grew into the person I’m proud to be now. Yes, I gained weight, I had to to survive. But (equally importantly), I discovered who I was, what was important to me and I moved my eating disorder out of the centre of my life. I started working and got married and while these may not be the most important things in life, they are symbolic of my stability. There are still things I struggle with but I would say I’m recovered because these small things do not rule my life, nor do they stop me doing what I want.

About the Author:

Frances Coleman-Williams is a writer using personal and professional experience to fight stigma and discrimination faced by people with mental health problems.

When The Dietician at the Hospital Doesn’t Understand Eating Disorders

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By: Elizabeth Janiello

“You are in good health, Elizabeth.” These are the words my dietician at the psychiatric hospital spoke to me. When she called me back to talk with her, I felt relieved. Finally, I can talk to someone in this hospital who understands eating disorders. Someone that can help me navigate the hospital while having an eating disorder. She sits me down, tells me my weight, and I instantly know that she has no clue how to work with patients with eating disorders. She didn’t ask what I’ve been eating since entering the hospital. She didn’t ask what I was eating before getting to the hospital. She simply said my height and weight and declared that I am in “great shape” and “very healthy”. She said, in broken English, “You are happy with your weight, yes?” Honestly, I respond no. I am not happy with my weight. She says, “You could lose a little, maybe a few pounds.” She asks, “Do you have a goal weight?” I respond with the weight I would like to weigh, one that I know is unhealthy, one that I know is meant for middle schoolers. But this is the weight I would like to be at. She responds, “Okay, that is fine.” She walks away.

Talk about a medical professional who knows nothing about eating disorders. I don’t know why I even expect anyone to understand eating disorders at this point. This is another reason I am so thankful for Project HEAL. I am fortunate enough to work with an entire team of specialists who SPECIALIZE in eating disorders. I am so very lucky.

I’d like to say that being here is helping me get better. But right now, I’m not so sure. I still feel stuck and defeated. And I know I’m letting my depression and anxiety get the best of me. Writing this has helped put me on a better path- a recovery-focused path.

Sitting in front of me is a banana, what I took for lunch from the cafeteria. To all those who are struggling and reading this, I am going to do something for you. I am going to eat this banana for you. It is literally the last thing I want to do. I am already in “restrictor mode” as I call it. But my outpatient dietician says that everyday we are given hundreds of opportunities to make decisions. For any given choice, one will be comfortable and safe, and one will be uncomfortable and scary. She told me to always chose the scary and uncomfortable choice. For me, restricting is safe and comfortable. I restrict when I’m scared, anxious, sad, angry, lonely, defeated, etc. Any emotion I’m feeling- I restrict. So, in this moment, I’m going to do the hard, scary, uncomfortable thing. I’m going to eat my banana. Right now, I’m doing it for you, for anyone who is reading this blog. But maybe one day soon, I’ll want to do it for me.

Lizzie studied Psychology at Hillsdale College, a small liberal arts school in Michigan. She currently works as a research assistant in Washington, D.C. She is in recovery and hopes to one day use her experiences to help others struggling with eating disorders. Lots of love and please stay strong! You’ve got this. 

Cultivating Joy in the Kitchen: A Caregiver’s Take on Meal Prep in Eating Disorder Recovery

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As the primary caregiver of an adult with an eating disorder, I often find myself navigating multiple roles as I support my partner in her recovery. On days when her eating disorder is particularly strong, I play the “parent”. I prepare and plate her food for her according to her meal plan, regardless of any excuse her eating disorder might have. One might think that at 29 years old my partner should be able to feed herself, but recovery in a sense, is about starting over. It’s about learning to feed oneself without their eating disorder controlling food decisions.

I’d be lying if I said I didn’t get frustrated at times when I have to take on this role, but it helps when I remind myself that food is thy medicine. I have to remind myself to stay present and that right now food for her is her prescription. She can’t miss a dose.

This is not always an easy task. If only a “spoon full of sugar” would help this medicine go down. As I help her complete her snacks and meals, I recognize and subsequently attempt to work through the internalized stigma and shame that I have recently become aware of that I hold. As someone who thankfully has had a “normal” relationship with food my entire life, I sometimes struggle to be understanding and compassionate.

Preparing dinner in our kitchen is part comical, part loving, part gratitude, part frustrating, and part sad. Food prep involves constant inquiries from my partner because she actually doesn’t know how to make something or she feels like she’s not cooking something “right” or she’s anxious and her mind is racing (it’s probably a combination of the three). As an observer to this, it’s interesting to see the eating disorder’s black and white way of thinking continually play out, even in moments of recovery. The dish she is helping me prepare has to be either correct or incorrect, which often leaves her slicing up vegetables or preparing sides dishes, while I cook the main dish.

This amazes me because this is the exact opposite as to why I love cooking and find it therapeutic. I too, like my partner, have a tendency to lean towards perfectionism, but in the kitchen I find that I can be haphazard and playful and the dish will still turn out great. I prefer cooking over baking because I don’t have to measure anything. I know that this lack of methodology and measuring cups is difficult for her, as it leaves much about the dish “unknown”. I know that sometimes it’s easier for her to not be in the kitchen while I’m cooking so she doesn’t see what’s going into a dish.

While I accept this struggle as where we’re at in recovery right now, I’m looking forward to see her move past the side dishes and be able to truly cook meals together that we are both excited to enjoy. Cooking is a past time for me. It’s a way for me to evoke and maintain joy and memories and I want to show my partner that experience with food is possible.

in love and support,


Jamie Dannenberg (CJ) is the primary carer of her partner, also named Jamie but referred to as OJ, who is in recovery from an eating disorder. As the partner of someone with an eating disorder and a registered dietitian, CJ has had to learn to navigate various roles in their relationship. With OJ, Jamie has become involved in global advocacy work and together they share their experience as a queer couple in recovery on their blog thirdwheelED. Follow them on Facebook, Twitter & Instagram.

Why Comparisons In Recovery Aren’t Helpful

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By: Melena Steffes

We’ve all done it. Whether it was comparing our own personal mountains, or milestones, comparison has snuck into our brains somewhere along the line. Eating disorders play games with your thought processes and when you’re sick it’s harder to see reality, so comparisons can make finding the truth that much more difficult.

Everybody’s recovery is so individualized, we’ve all experienced things differently and cope with things in our own ways. So when we take something as personal as our recovery, and compare it to those around us, it can be really damaging. The only truth we really have, is our own. We can’t really tell where those around us are in recovery, someone else’s middle won’t look the same as ours, especially if we’re still working on our beginning stages.

It’s really easy to find ways to compare ourselves. Sometimes, for example, seeing people’s posts online can become problematic when we perceive others as being further ahead in recovery than we are. I remember when I was pretty new to recovery, and I followed other people’s blogs who were also documenting their journeys, I felt like I was doing everything wrong. When my body changed differently, I felt inadequate and even more self-conscious, especially when I saw “progress pictures.” When my coping skills didn’t work similarly, I felt like I was some kind of poser, or like I wasn’t trying hard enough. I had a Tumblr that I kept through the start of my recovery and it kept me stuck in my thoughts. Once I realized that, I deleted it, even though I didn’t completely want to. But it helped allow me to heal, so now I am able to look at things like that with a new perspective, with a healthier brain.

The same things happened once I entered treatment for the first time, and the second, etc. The comparisons occurred continuously and it was really hard to teach myself that they weren’t doing me any favors.

It was really hard sit at the table during lunch when I looked at my meal plan and then looked around at those surrounding me. It was hard to pick my afternoon snack without looking to see what other people were choosing. I did this with pretty much everything. It happened partially because I felt like I wasn’t worthy of being in treatment, and because I couldn’t always take my eating disorder seriously. I can’t even count how many times I’ve told providers that I felt like I was taking up a bed that was more deserved by somebody else.

Whether comparison was to positive aspects of my recovery, or to eating disorder behaviors, it always chipped away at my recovery, regardless. But, with a lot of hard work, I have made doing so a non-option. I started to, whether this phrase has become cliché or not, take it day by day. I had to redirect myself when I found myself choosing a snack based on somebody else’s selections, or when I caught myself checking out others’ plates at lunch.

Even outside of recovery friends, I would still check myself against friends from other places or my family. I would look at people I saw on commercials, etc., and just think to myself that I needed desperately to change something about myself to be “better.” None of this ever helped or made me happier.

Reminders that my recovery may mean doing different things than others to progress was a realization that was really important. It started with me trying to forgive myself daily for things that I considered to be mistakes. It meant forgiving myself for not being the same as those around me. I had to let myself start over, daily. I needed to let myself try again and stop letting one missed exchange, allow my entire day to snowball out of control. I had to stop beating myself up for not doing my meal plan perfectly. Forgiveness of myself is an ongoing fight, but allowing myself to recover in my own way, and at my own pace, released me into climbing my mountains in the ways I needed.

Recovery, to me, has a variety of ‘mountains’. And comparisons are one of them. Climbing my way to the top, to conquer it, was challenging. Sometimes I still find myself slipping back into it, but I always remind myself that it always hurt more than it helped.

My recovery is mine. My path is mine, and won’t always look like the ones I see online, or in others around me. My life won’t always match the one that I think I’m supposed to have. And that’s okay.

It’s important to remind yourself that you didn’t fall down the rabbit hole of becoming sick just as somebody else, so you won’t climb your own mountains just as they do either.