What is CBT-AR; and how can it be delivered via telehealth
And so really I just bring all of this up to highlight that I
think that our food treatment should really target these
mechanisms. We need to help people with their lack of hunger. We
need to help people with their anxiety. And we need to help
people with the fact that they might be a little extra sensitive
to trying certain foods for the first time.
Cognitive Behaviral Therapy for ARFID (CBT-AR)
So that leads me to what is cognitive behavioral therapy for
ARFID or CBT-AR, and how can it be delivered through telehealth?
Okay. CBT-AR is a flexible modular treatment for children,
adolescents, and adults that comprises about 20 sessions over
four stages. The stages include psycho-education.
Tips on delivering CBT on eating disorders via telehealth
As we go through the protocol in what CBT-AR is, I'm going to be
giving you guys some tips for how to deliver it over a
telehealth. A lot of the tips actually come from a beautiful
paper that Glenn Waller and his colleagues published in the
international journal of eating disorders almost a year ago
now. I'm highlighting this here because this is actually an open
access paper. So even if you don't have a subscription to like a
university library or to the IJED, you actually can download
this totally for free. So I would really recommend checking out
this article and I will be integrating tips from it. So it's
called Cognitive-behavioral therapy in the time of coronavirus:
Clinician tips for working with eating disorders via telehealth
when face-to-face meetings are not possible.
For whom is CBT-AR appropriate?
For whom is CBT-AR appropriate? Well, we designed this treatment
for children, adolescents, or adults who have ARFID, who are
cognitively able to engage in treatment, who are ages 10 and up,
who if they have a developmental disorder is fairly mild, who
are eating by mouth and don't require tube feeding, and who are
being monitored by a physician because, again, ARFID can have
very serious medical consequences and patients can be at risk
for re-feeding syndrome.
My first telehealth tip is that if you're going to be delivering
this treatment completely virtually, which is actually what
we're doing here in our clinic in Boston, we're doing all of it
over an encrypted Zoom platform is that you want to make sure
that even if you, as say the mental health clinician, are seeing
the patient virtually, that there has been a medical evaluation
that is in person and that's crucial both to establish how much
the patient weighs, what their vital signs might look
like. Maybe if they need some blood testing to look for
nutritional deficiencies. And for patients who are very
underweight and compromised, they might continue to need ongoing
in-person medical monitoring even if, again, the mental health
component is virtual.